Trial investigates if acetaminophen aggravates asthma symptoms

Young children with asthma who take acetaminophen to alleviate pain or fever are no more likely than those who take ibuprofen for this purpose to experience asthma complications, a randomized, double-blind trial showed. The trial was conducted in 300 children aged from 1 to 5 years with mild persistent asthma who were assigned to receive either acetaminophen or ibuprofen when needed during the course of 46 weeks. Children in both groups also received standardized asthma-controller therapies.

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The 2 groups experienced about the same number of asthma exacerbations-a mean of 0.81 per participant with acetaminophen and 0.87 per participant with ibuprofen. In the acetaminophen group, 49% of participants had at least 1 asthma exacerbation during the study period, and 21% had at least 2, similar to the 47% and 24%, respectively, in the ibuprofen group. The proportion of asthma-control days also was parallel in the 2 groups: 85.8% for those taking acetaminophen and 86.8% for those taking ibuprofen. Likewise, the groups did not differ significantly with regard to use of an albuterol rescue inhaler, making an unscheduled healthcare visit for asthma, or experiencing an adverse event (Sheehan WJ, et al. N Engl J Med. 2016;375[7]:619-630).

Commentary

For years, practitioners have been concerned that acetaminophen causes or worsens asthma, and case-controlled studies and a plausible biologic mechanism offered support for the concern. This large, multicenter, prospective, randomized trial gets acetaminophen at least partially off the hook by showing that children with diagnosed asthma are no worse off with acetaminophen than they are with ibuprofen. We don’t know if asthmatic children would be best off with neither, nor do we know from this study whether early use of acetaminophen promotes the initial development of asthma. These are questions for another study, another day. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.