Article

The Association of Acetaminophen and Asthma Prevalence and Severity

Department of Pediatrics, Akron Children's Hospital, Akron, OH 44308, USA.
PEDIATRICS (Impact Factor: 5.3). 11/2011; 128(6):1181-5. DOI: 10.1542/peds.2011-1106
Source: PubMed

ABSTRACT The epidemiologic association between acetaminophen use and asthma prevalence and severity in children and adults is well established. A variety of observations suggest that acetaminophen use has contributed to the recent increase in asthma prevalence in children: (1) the strength of the association; (2) the consistency of the association across age, geography, and culture; (3) the dose-response relationship; (4) the timing of increased acetaminophen use and the asthma epidemic; (5) the relationship between per-capita sales of acetaminophen and asthma prevalence across countries; (6) the results of a double-blind trial of ibuprofen and acetaminophen for treatment of fever in asthmatic children; and (7) the biologically plausible mechanism of glutathione depletion in airway mucosa. Until future studies document the safety of this drug, children with asthma or at risk for asthma should avoid the use of acetaminophen.

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    • "compared with children who received paracetamol [49]. Paracetamol use during pregnancy has been implicated in asthma development and the increasing incidence of asthma in adults and children in epidemiologic, observational and pathophysiologic studies (reviewed in [50–52] and more recently in a prospective birth cohort study [53]). Given the widespread use of paracetamol in children, there has been a call for causation to be proved or disproved in adequately powered placebo-controlled trials [54], and clearly more research is required in this field. "
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    ABSTRACT: Fever is a common symptom of childhood infections that in itself does not require treatment. The UK's National Institute for Health and Care Excellence (NICE) advises home-based antipyretic treatment for low-risk feverish children only if the child appears distressed. The recommended antipyretics are ibuprofen or paracetamol (acetaminophen). They are equally recommended for the distressed, feverish child; therefore, healthcare professionals, parents and caregivers need to decide which of these agents to administer if the child is distressed. This narrative literature review examines recent data on ibuprofen and paracetamol in feverish children to determine any clinically relevant differences between these agents. The data suggest that these agents have similar safety profiles in this setting and in the absence of underlying health issues, ibuprofen seems to be more effective than paracetamol at reducing NICE's treatment criterion, 'distress' (as assessed by discomfort levels, symptom relief, and general behavior).
    Drugs in R & D 06/2014; 14(2). DOI:10.1007/s40268-014-0052-x · 1.71 Impact Factor
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    • "The argumentative basis for a causal role of early childhood use of paracetamol in asthma development has recently been summarized [69] (cited in italics below), allowing a point-by-point inspection of its soundness. "
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    ABSTRACT: AIM: The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mounting evidence, which is reviewed here, points to various confounding factors as the major reasons for these reported associations. METHODS: PubMed and EMBASE were systematically searched for studies on associations between antibiotics and/or paracetamol with asthma and/or wheezing, published up to November 2012. A total of 64 pertinent studies were identified, 35 focusing on antibiotics, 19 on paracetamol, and ten addressing both antibiotics and paracetamol, bringing the number of relevant datasets to 74. RESULTS: Numerous studies were cross-sectional and made no adjustment for the indication of antibiotics or paracetamol; consequently, they were unable to dismiss possible confounding by indication. Where such adjustments could be performed (mostly in longitudinal studies), they substantially weakened or entirely eliminated the association with asthma or asthma surrogates present in the unadjusted data. CONCLUSION: The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. Truly indicated antibiotics should not be withheld from infants or young children for fears they might develop asthma. Likewise, there is no sound reason to replace paracetamol as the preferred pain relief and fever medication in this age group.
    European Journal of Clinical Pharmacology 01/2013; 69(6). DOI:10.1007/s00228-012-1463-7 · 2.70 Impact Factor
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    • "Several studies have suggested associations between acetaminophen in childhood and the risk of asthma [54, 146–150]. A recent review summarized the existing evidence for the associations of acetaminophen use with childhood asthma, and suggested that this association might be causal based on various epidemiological findings including the strength, consistency, and dose–response relationship [151]. Also, the metabolism of acetaminophen leads to a depletion in airway mucosal glutathione that could contribute to vulnerability to oxidant stress. "
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    ABSTRACT: Previous studies have suggested that asthma, like other common diseases, has at least part of its origin early in life. Low birth weight has been shown to be associated with increased risks of asthma, chronic obstructive airway disease, and impaired lung function in adults, and increased risks of respiratory symptoms in early childhood. The developmental plasticity hypothesis suggests that the associations between low birth weight and diseases in later life are explained by adaptation mechanisms in fetal life and infancy in response to various adverse exposures. Various pathways leading from adverse fetal and infant exposures to growth adaptations and respiratory health outcomes have been studied, including fetal and early infant growth patterns, maternal smoking and diet, children's diet, respiratory tract infections and acetaminophen use, and genetic susceptibility. Still, the specific adverse exposures in fetal and early postnatal life leading to respiratory disease in adult life are not yet fully understood. Current studies suggest that both environmental and genetic factors in various periods of life, and their epigenetic mechanisms may underlie the complex associations of low birth weight with respiratory disease in later life. New well-designed epidemiological studies are needed to identify the specific underlying mechanisms. This review is focused on specific adverse fetal and infant growth patterns and exposures, genetic susceptibility, possible respiratory adaptations and perspectives for new studies.
    European Journal of Epidemiology 01/2012; 27(1):5-14. DOI:10.1007/s10654-012-9657-y · 5.15 Impact Factor
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