Nav: Home

Acetaminophen does not aggravate children's asthma

August 17, 2016

Contrary to earlier reports, giving acetaminophen (Tylenol, etc.) for pain and fever does not worsen asthma in young children with the condition, concludes a randomized trial in the August 18 New England Journal of Medicine.

The Acetaminophen Versus Ibuprofen in Children with Asthma (AVICA) trial, led by researchers at Boston Children's Hospital for the National Heart, Lung and Blood Institute's Asthma Network (AsthmaNet), is the only blinded, randomized, controlled trial to date to prospectively compare acetaminophen head-to-head with ibuprofen (Motrin, etc.) in children with asthma.

The 18-site study should settle a debate that originated when several retrospective studies seemed to indicate that children had exacerbations of their asthma when receiving Tylenol for pain and/or fever.

"We found no matter how you slice it, there was absolutely no difference between Tylenol and Motrin," says senior investigator and corresponding author Wanda Phipatanakul, MD, MS, of Boston Children's Hospital's Division of Allergy and Immunology. "Our findings should alleviate the concerns for safety that were based on observational data."

The study enrolled 300 children 1 to 5 years old with mild persistent asthma. Their families were randomized to use either acetaminophen or ibuprofen as indicated for pain and fever over a 48-week period.

Both groups received the same asthma control therapies: daily inhaled glucocorticoids, as needed inhaled glucocorticoids, and daily oral leukotriene receptor antagonist. (The asthma therapies were given in varying order as part of a concurrent randomized trial, making this, in effect, a "trial within a trial.") Medication adherence was closely monitored.

Of the original 300 children, 226 (75 percent) completed the study. Children in the acetaminophen and ibuprofen groups used similar amounts of these medications for pain and/or fever (median, 5.5 doses).

During the 48 weeks, there were no statistically significant differences between groups:
  • The number of asthma exacerbations per child averaged 0.81 in the acetaminophen group versus 0.87 in the ibuprofen group.

  • At least one asthma exacerbation occurred in 49 percent of the acetaminophen group, vs. 47 percent of the ibuprofen group. At least two episodes occurred in 21 and 24 percent, respectively.

  • The percentage of days with full asthma control were virtually the same for acetaminophen and ibuprofen: 85.8 and 86.8 percent, respectively.

  • Use of "rescue" medication (albuterol) was essentially the same: 2.8 vs. 3.0 puffs per week.

  • Unscheduled healthcare visits for asthma were equivalent, averaging 0.75 vs. 0.76 episodes per child.

While the study was modest in size, it was powered to detect any clinically significant differences, more so than past retrospective studies, Phipatanakul notes. "There was no difference that would cause me to be alarmed," she says.

The researchers note that earlier studies linking acetaminophen with increased asthma symptoms did not use a randomized design. Those studies therefore couldn't rule out the possibility that the asthma exacerbations were caused by the respiratory infections themselves.

"The toddler age is a wheezy age when kids are developing asthma, but they also get a lot of fevers and colds," says Phipatanakul. "Without a randomized design, it's hard to tease out the effects of medications."

Since the study was limited to young children with mild persistent asthma receiving asthma controller therapy, the authors also note that their findings may not apply to other age groups or children with more severe asthma. Further studies will be necessary to answer those questions.
-end-
William J. Sheehan, MD, of Boston Children's Hospital was first author on the paper. The study was funded by The National Heart, Lung and Blood Institute's Asthma Network (AsthmaNet) and grants from the National Institutes of Health (HL098102, HL098096, HL098075, HL098090, HL098177, HL098098, HL098107, HL098112, HL098103, HL098115, TR001082, TR000439, TR000448, TR000454, K23AI104780, and K24AI106822).

About Boston Children's Hospital

Boston Children's Hospital is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 11 members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's today is a 404-bed comprehensive center for pediatric and adolescent health care. Boston Children's is also the primary pediatric teaching affiliate of Harvard Medical School. For more, visit our Vector and Thriving blogs and follow us on our social media channels: @BostonChildrens, @BCH_Innovation, Facebook and YouTube.

Boston Children's Hospital

Related Asthma Articles:

Insomnia prevalent in patients with asthma
A team of researchers from the University of Pittsburgh has found that insomnia is highly prevalent in adults with asthma and is also associated with worse asthma control, depression and anxiety symptoms and other quality of life and health issues.
Test used to diagnose asthma may not be accurate
A new study urges caution in the use of the mannitol challenge test for asthma in non-clinical settings.
Turning off asthma attacks
Working with human immune cells in the laboratory, Johns Hopkins researchers report they have identified a critical cellular 'off' switch for the inflammatory immune response that contributes to lung-constricting asthma attacks.
Access to asthma meds, plus flu vaccines, keep kids with asthma healthy
Kids need flu shots to prevent asthma flares, and medications available in school to keep 86 percent in class, according to two studies being presented at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.
Discovery could lead to better asthma treatment
Scientists have made a discovery that could lead to improved treatment for asthma sufferers.
More Asthma News and Asthma Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.