ACETAMINOPHEN VS. IBUPROFEN: WHICH IS SAFER FOR CHILDREN WITH ASTHMA?

FCAAIA Notes: A few years ago, there was some discussion in the literature (that has since faded away) as to whether early use of acetaminophen (Tylenol and other brands) was a risk factor for developing asthma. More than 3 years ago, I asked whether it might be those needing acetaminophen for any reason who were already predisposed to develop asthma.

This study further supports the safety of acetaminophen in patients who already have asthma as its use was not associated any more frequent or severe asthma flares than did ibuprofen (Motrin, Advil, and other brands).

(Source: https://www.doximity.com/doc_news/v2/entries/4484476?_eda_link_uuid=943aada5-c1d7-4deb-b3c0-2d4d4f8cb75c&_r=1&_ref=digest&clicked=true&position=8&signature=adcbd8430dc397246f53ce917b919dae918b61c9&source=email_doc_news%3A%3Aspecialty_digest&token=26fb79fd6cf913cc4dac88b398c504a595ac4e1c&user_id_hash=8f9d6c02f29de56b1f7ed856542ced553281a8be&login_from_email=mrlester602%40gmail.com August 27, 2016)

BACKGROUND: Studies have suggested an association between frequent acetaminophen use and asthma-related complications among children, leading some physicians to recommend that acetaminophen be avoided in children with asthma; however, appropriately designed trials evaluating this association in children are lacking.

METHODS: In a multicenter, prospective, randomized, double-blind, parallel-group trial, we enrolled 300 children (age range, 12 to 59 months) with mild persistent asthma and assigned them to receive either acetaminophen or ibuprofen when needed for the alleviation of fever or pain over the course of 48 weeks. The primary outcome was the number of asthma exacerbations that led to treatment with systemic glucocorticoids. Children in both groups received standardized asthma-controller therapies that were used in a simultaneous, factorially linked trial.

RESULTS: Participants received a median of 5.5 doses (interquartile range, 1.0 to 15.0) of trial medication; there was no significant between-group difference in the median number of doses received (P=0.47). The number of asthma exacerbations did not differ significantly between the two groups, with a mean of 0.81 per participant with acetaminophen and 0.87 per participant with ibuprofen over 46 weeks of follow-up (relative rate of asthma exacerbations in the acetaminophen group vs. the ibuprofen group, 0.94; 95% confidence interval, 0.69 to 1.28; P=0.67). In the acetaminophen group, 49% of participants had at least one asthma exacerbation and 21% had at least two, as compared with 47% and 24%, respectively, in the ibuprofen group. Similarly, no significant differences were detected between acetaminophen and ibuprofen with respect to the percentage of asthma-control days (85.8% and 86.8%, respectively; P=0.50), use of an albuterol rescue inhaler (2.8 and 3.0 inhalations per week, respectively; P=0.69), unscheduled health care utilization for asthma (0.75 and 0.76 episodes per participant, respectively; P=0.94), or adverse events.

CONCLUSIONS:Among young children with mild persistent asthma, as-needed use of acetaminophen was not shown to be associated with a higher incidence of asthma exacerbations or worse asthma control than was as-needed use of ibuprofen.

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