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More evidence needed to link paracetamol, childhood asthma
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The relationship between early life exposure to paracetamol and asthma development may often be exaggerated, and there is currently insufficient evidence to merit warnings about restricting paracetamol use, according to study results.
The researchers said that since paracetamol is used to treat respiratory tract infections — a known risk factor for childhood asthma — it remains uncertain whether paracetamol causes asthma or if the association is due to confounding by respiratory infections.
“Fever and pain caused by respiratory tract infections leads to increased paracetamol use, and it is well established that early life respiratory tract infections, particularly those caused by rhinoviruses and respiratory synctial viruses, are associated with asthma,” Mweene Cheelo, MSc, from the Allergy and Lung Health Unit in the Centre for Epidemiology and Biostatistics at the University of Melbourne, and colleagues wrote.
To assess the available evidence on the association between paracetamol exposure and asthma in childhood, the researchers performed a systematic review of longitudinal studies examining paracetamol exposure in utero or during pregnancy and the development of childhood asthma. From 1,192 potentially relevant studies, the researchers identified 11 that met inclusion criteria for analysis.
Researchers found that any paracetamol use during the first trimester was associated with an increased risk for childhood asthma (pooled OR=1.39, 95% CI, 1.01-1.91), but the researchers noted discernible heterogeneity between studies, only one of which accounted for maternal respiratory tract infections.
Cheelo and colleagues observed that increased frequency of paracetamol during infancy was linked to greater odds of childhood asthma (pooled OR=1.15, 95% CI, 1-1.31 per doubling of days of exposure). However, following adjustment for respiratory tract infections, researchers said the association was diminished (OR=1.06, 95% CI, 0.92-1.22).
“Respiratory tract infections appear to confound this association and it is essential that this be accounted for in future observational studies,” the researchers wrote. “Future studies should also assess the effect of paracetamol exposure on lung function outcomes given that paracetamol is proposed to induce oxidative stress on the airway.”
Disclosure: The researchers report no relevant financial disclosures.
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