Patricio, Crisanto BSN II-A/ Group II

Is Acetaminophen a Culprit in Asthma? (Positive associations exist between acetaminophen use and asthma in children.) During the past decade, epidemiologic studies have shown a positive association between acetaminophen use and asthma prevalence and severity in adults and children. In a special article in Pediatrics, a pediatric pulmonologist reviews these data. Results from a large international study showed a significant threefold higher risk for current asthma in 6- and 7-year-olds who took acetaminophen at least once per month. The authors of this study assert that if acetaminophen does indeed exacerbate asthma, it would account for about 40% of the population-attributable risk for severe asthma symptoms. But what if children with asthma are just more likely to take acetaminophen, or have viral infections that lead to both asthma symptoms and acetaminophen use? In the Boston University Fever Study, researchers randomized febrile children (age range, 6 months12 years) to receive acetaminophen or ibuprofen for fever. In the subset of children with asthma, those who received acetaminophen were twice as likely to have a subsequent outpatient asthma visit as those who received ibuprofen. Also noted in the review are studies that have shown dose-response associations, the observation that asthma prevalence and acetaminophen sales have increased in tandem during recent decades, and a plausible mechanism of action by which acetaminophen could increase susceptibility to asthma by depleting airway mucosal glutathione.

Reference: http://pediatrics.jwatch.org/cgi/content/full/2011/1221/1

Comment: The author of this review draws conclusions from observational data as well as a pediatric randomized controlled trial suggesting that acetaminophen use contributes to asthma exacerbations in individuals and to increased asthma prevalence in the general pediatric population. Although the author of the review now discourages acetaminophen use in children with asthma or a family history of asthma, he raises the possibility that confounding variables might explain some or all of the associations. I agree that acetaminophen use is often unnecessary and fueled by "fever phobia" and that inappropriate dosing can be a problem. However, I would like to see additional experimental studies in children with asthma before I subscribe to "acetaminophen phobia."