NSAID-exacerbated respiratory disease — ORE Part 1 MCQ

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ModerateDental Pharmacology and TherapeuticsNSAID-exacerbated respiratory diseaseORE Part 1

A 51-year-old asthmatic patient needs analgesia after extraction. He reports wheeze and an emergency department visit after taking ibuprofen previously. He has no liver disease and drinks minimal alcohol. What is the most appropriate treatment?

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Correct answer: B — Paracetamol within recommended dosing limits

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · E = shown as D · C = shown as E

The correct answer is A. The patient has NSAID-exacerbated respiratory disease (NERD)—characterised by asthma with documented hypersensitivity to NSAIDs (prior ED attendance with wheeze after ibuprofen). In NERD, all NSAIDs (including aspirin, ibuprofen, diclofenac) are contraindicated because they trigger acute bronchospasm and airway hypersensitivity regardless of dose. The first-line management of NERD is NSAID avoidance. Paracetamol is the evidence-based alternative analgesic and is safe in this patient (no liver disease or significant alcohol consumption). B, C, and D are all NSAIDs and are contraindicated. E (codeine monotherapy) is suboptimal for post-extraction analgesia because it is less effective for moderate-to-severe pain; codeine is listed as an alternative but paracetamol is preferred first-line.

Reference: NHS Specialist Pharmacy Service. Using NSAIDs in asthma. January 2025. https://sps.nhs.uk/articles/using-nsaids-in-asthma/ AND Cochrane review: Oral and intranasal aspirin desensitisation for NSAID-exacerbated respiratory disease. Published January 2025 (DOI: see PubMed 39775459)