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Acetaminophen well-tolerated in children with mild persistent asthma

As-needed use of acetaminophen was well-tolerated and did not increase asthma exacerbations or worsen asthma control in young children with mild persistent asthma compared to use of ibuprofen, according to recent research.

“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,” William J. Sheehan, MD, assistant of medicine and instructor in the division of allergy and immunology at Boston Children’s Hospital and Harvard Medical School, and colleagues wrote. 

Sheehan and colleagues performed a multicenter, double blind, parallel-group trial to assess whether acetaminophen was associated with higher asthma-related morbidity compared with ibuprofen. A total of 300 children aged 1 to 5 years with mild persistent asthma were included in the 48-week study.

Subjects were randomly assigned into two treatment groups to receive either acetaminophen or ibuprofen (n = 150 for each). Each caregiver provided their child with the assigned trial medication to relieve fever or pain.

All participants required standardized asthma-controller therapies to manage their asthma.

Participants received a median of 5.5 doses (interquartile range, 1 to 15) of medication during the study period with no significant difference between trial groups (P = 0.47).

The number of asthma exacerbations also did not significantly differ between groups. Over 46 weeks of follow-up, children taking acetaminophen had a mean of 0.81 exacerbations, while children taking ibuprofen had a mean of 0.87 exacerbations (RR = 0.94; 95% CI, 0.69 to 1.28).

At least one asthma exacerbation occurred in 49% of the acetaminophen group and 47% of  the ibuprofen group. At least two asthma exacerbations occurred in 21% of the acetaminophen group and 24% of the ibuprofen group.

Overall, researchers did not identify worse asthma conditions in children treated with acetaminophen compared to ibuprofen. The number of asthma-control days (acetaminophen, 85.8% vs. ibuprofen 86.8%), need for rescue medication (2.8 inhalations per week vs. 3.0 inhalations per week), unscheduled medical visits for asthma (0.75 episodes per patient vs. 0.76 episodes per patient), and adverse events were similar in both groups.

“Over the 1-year study period, we did not find that asthma exacerbations or other markers of asthma-related complications occurred more frequently among children who were randomly assigned to receive acetaminophen than among those who were randomly assigned to receive ibuprofen,” Sheehan and colleagues wrote. – by Alaina Tedesco