Medications Contraindicated in Asthma

Absolute Contraindications

• The American Thoracic Society recommends that sedatives are absolutely contraindicated in patients with acute severe asthma or during exacerbations, as they worsen respiratory depression and can precipitate respiratory failure 1, 2, 3, 4
• The American Academy of Otolaryngology-Head and Neck Surgery suggests that any sedation is contraindicated in patients with acute severe asthma or during exacerbations, and this prohibition applies to all sedating medications including benzodiazepines, barbiturates, and sedating antipsychotics like quetiapine 1, 2, 4

Relative Contraindications and Cautions

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that patients with uncontrolled or severe asthma should not receive allergen immunotherapy due to increased risk of severe systemic reactions and fatal anaphylaxis 5
• The American Academy of Otolaryngology-Head and Neck Surgery suggests that immunotherapy should be postponed until asthma is well-controlled with stable lung function and minimal symptoms, and withheld if asthma symptoms have worsened since the last visit 5

Medications to Avoid in Specific Clinical Scenarios

• The American Thoracic Society recommends that antibiotics should not be prescribed unless bacterial infection is clearly documented during acute exacerbations, as routine antibiotic use provides no benefit and contributes to resistance 1, 3
• The American Thoracic Society suggests that percussive chest physiotherapy is unnecessary and should be avoided during acute exacerbations 1, 3