Acetaminophen is not the best choice for fever in asthmatics

Children with asthma who use a nonsteroidal anti-inflammatory drug (NSAID) during a respiratory infection or no antipyretic at all have a lower risk of experiencing an asthma exacerbation (AE) than asthmatics who use acetaminophen. These were the findings of an analysis of data from a national database in Taiwan related to more than 27,000 children with asthma who had at least one episode of respiratory infection and a similar number of age-and sex-matched non-asthmatic children with respiratory infection who served as controls.

Participants were divided into 3 groups: acetaminophen use, NSAID cyclooxygenase-1 (COX-1) use, and no antipyretic use. Overall, asthmatic patients used antipyretics less often than controls (48.5% vs 55.5%) with antipyretic users in the asthmatic group tending to be older than nonusers (9.3 vs 7.8 years).

Investigators compared the rate of AE occurrence within the first 7 days after diagnosis of respiratory infection among the groups and analyzed the risk of AE with adjustments for age, gender, and urbanization level. The overall rate of AE within 7 days of a single respiratory infection episode was low—about 0.14%, with no observable difference in rate between those who used antipyretics and those who did not. The risk of AE was highest in those who took acetaminophen (Chung R-S, et al. Pediatrics & Neonatology. 2020; Epub ahead of print).

Thoughts from Dr. Farber

Because of the potential adverse effects of aspirin in children with asthma, some pediatricians avoid using NSAIDs in these children. This study suggests that acetaminophen may be a worse option. However, the risk is very low, so if acetaminophen is your preferred antipyretic in a given child (and I do support making miserable children feel better), use it.