Should children with asthma avoid acetaminophen? (Tylenol)
By- Dr. Jonathan Wood

The incidence of pediatric asthma increased dramatically between 1980 and 2000. During that same time period, the association between aspirin and the severe neurologic disease, Reye's Syndrome, became apparent. Consequently, the use of acetaminophen, a non-aspirin pain reliever/fever reliever, increased dramatically.

Increased incidence of asthma and increased use of acetaminophen - - is there an association? Perhaps. We, as yet, have no satisfactory explanation for why pediatric asthma incidence has risen and then seemed to level off. The leveling off, by the way, coincides with the leveling off and acceptance of acetaminophen as the primary analgesic/antipyretic in children by the mid-late 1990's.

This coming month, in the journal Pediatrics, John McBride MD, a prominent pediatric lung specialist and researcher has pulled together this data and many other alluring studies to make a strong case that the use of acetaminophen (1) may well be responsible for the increased incidence of asthma and (2) may correlate with increased severity of asthma. The argument is strong and comes from a valid and respected source.

For example:
· An enormous worldwide epidemiologic study looked at more than 500,000 children with asthma and concluded the following:
o Children 6-7 yr old using acetaminophen monthly had more than 3-fold increase in asthma
o For 13-14 yr olds, it was close 2.5 times the incidence
o For less frequent use (less than monthly, but at least yearly) the increases were still 1.6 and 1.4 times respectively.
· Other studies have corroborated this data in a variety of cultural, socioeconomic, and geographically diverse settings.
· Several adult studies apparently demonstrate similar findings

These are associations, not proof of causation. Nonetheless, they are worth consideration.

And what about asthma severity? Prospective studies have been done comparing acetaminophen (Tylenol) and ibuprofen (Advil) in the context of asthma severity. Again, these suggest an association between more severe pediatric asthma and acetaminophen use: those kids using actaminophen had more severe disease than those using ibuprofen. Unfortunately, no study has ever looked at this with a placebo control, the good standard. Still, while we wait for that, the current data is alluring.

What if we could reduce the use of something that would, if eliminated reduce asthma incidence in the population by 35-45 percent? Would we act on this? Yes.
How simple would it be for children with asthma to avoid acetaminophen whenever possible? Easy.
Are there viable alternatives for most circumstances? Yes. Ibuprofen is one.
Would there still be times when the use of acetaminophen is warranted? Yes.

My advice?
1 - Keep your eyes open. This issue is going to be discussed more and more.
2 - Consider limiting or eliminating acetaminophen use if you or your child has asthma

Fever?
1 - Why are we worrying so much about fever anyway? Fever is generally not a bad thing.
2 - Review "The Truth About Fever" in the Healthy Living archive.

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