Acetaminophen use and Asthma: Are they associated?
A recent article in New England Journal of Medicine(NEJM) , “Acetaminophen versus Ibuprofen in Young Children with Mild Persistent Asthma” published on August 18 2016, looked at the association between frequent acetaminophen use and asthma-related complications among children.
Acetaminophen is the drug of choice for fever in young children. Pediatricians, parents, and caregivers consider it to be safe for most children when it is administered in accordance with the manufacturer’s directions for use. In 2000, however, concern was raised about the safety of acetaminophen that suggested that frequent use of acetaminophen among adults was associated with asthma, and among those who already had asthma, with more severe disease.
In previous studies evaluating an association between acetaminophen use and asthma in children, viral respiratory illnesses are the most common causes of wheezing among children with asthma, but because these illnesses also cause fever and aches (two potential indications for acetaminophen), it is difficult to determine a causal association. Therefore, there was a need to do further study.
The Acetaminophen versus Ibuprofen in Children with Asthma (AVICA) trial, reported by Sheehan et al. in August issue of NEJM attempts to provide some answers. The AVICA trial was a 48-week randomized, double-blind, parallel-group trial that compared the as-needed use of acetaminophen with that of ibuprofen for fever or pain in 300 children 12 to 59 months of age at enrollment who had mild persistent asthma and were receiving treatment with asthma-controller therapies. After a run-in period, the children were randomly assigned to receive acetaminophen or ibuprofen, as needed, as antipyretic, analgesic therapy.
The investigators did not find any significant difference in the primary outcome of asthma exacerbations leading to treatment with systemic glucocorticoids between the two treatment groups over the course of 48 weeks.
What does it mean for our healthy and asthma patients?
- We do not have any answers of whether acetaminophen use can lead to the development of asthma in otherwise healthy children.
- Caregivers of young children who are receiving treatment with asthma-controller medications may be reassured by this result that the use of acetaminophen in usual, as- needed doses will not worsen asthma symptoms in their children and that acetaminophen and ibuprofen can be used similarly in situations for which they are indicated.
- The trial does not directly answer the question of whether the use of acetaminophen or ibuprofen, as compared with no drug use, can worsen asthma.
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