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Is Acetaminophen a Culprit in Asthma?

Positive associations exist between acetaminophen use and asthma in children.

During the past decade, epidemiologic studies have shown a positive association between acetaminophen use and asthma prevalence and severity in adults and children. In a special article in Pediatrics, a pediatric pulmonologist reviews these data.

Results from a large international study showed a significant threefold higher risk for current asthma in 6- and 7-year-olds who took acetaminophen at least once per month. The authors of this study assert that if acetaminophen does indeed exacerbate asthma, it would account for about 40% of the population-attributable risk for severe asthma symptoms. But what if children with asthma are just more likely to take acetaminophen, or have viral infections that lead to both asthma symptoms and acetaminophen use? In the Boston University Fever Study, researchers randomized febrile children (age range, 6 months–12 years) to receive acetaminophen or ibuprofen for fever. In the subset of children with asthma, those who received acetaminophen were twice as likely to have a subsequent outpatient asthma visit as those who received ibuprofen.

Also noted in the review are studies that have shown dose-response associations, the observation that asthma prevalence and acetaminophen sales have increased in tandem during recent decades, and a plausible mechanism of action by which acetaminophen could increase susceptibility to asthma by depleting airway mucosal glutathione.

Comment: The author of this review draws conclusions from observational data as well as a pediatric randomized controlled trial suggesting that acetaminophen use contributes to asthma exacerbations in individuals and to increased asthma prevalence in the general pediatric population. Although the author of the review now discourages acetaminophen use in children with asthma or a family history of asthma, he raises the possibility that confounding variables might explain some or all of the associations. I agree that acetaminophen use is often unnecessary and fueled by "fever phobia" and that inappropriate dosing can be a problem. However, I would like to see additional experimental studies in children with asthma before I subscribe to "acetaminophen phobia."

— Cornelius W. Van Niel, MD

Published in Journal Watch Pediatrics and Adolescent Medicine December 21, 2011

Citation(s):

McBride JT. The association of acetaminophen and asthma prevalence and severity. Pediatrics 2011 Dec; 128:1181.

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

• Acetoaminophen and asthma
  Bernard Yablin, URMC Peds Retired Asst Clin Prof, 27 Dec 2011 11:59 AM EST
  Specialty: Pediatrics
  This information should be made available to college and university student health services where Tylenol may be regularly dispensed.
• Acetaminophen and asthma
  Henry L. de Give, Washington state., 3 Jan 2012 3:05 PM EST
  Specialty: Pediatrics
  This discourse is beginning to look disturbingly similar to the ones that preceded the identification of aspirin as the culprit... [more]
• Acetaminophen and asthma
  Martha Dodge, 9 Jan 2012 12:36 PM EST
  Specialty: Inactive (Retired)
  Very interesting article. I have two grandsons who have asthma and they are given Tylenol often!!
• Acetaminophen and Asthma
  N. A. Zane, MD, ABIM, Bethesda Memorial Hosp, Boynton Bch, FL, 18 Jan 2012 12:35 PM EST
  Specialty: Internal Medicine
  This article is confusing since NSAIDs (of which ibuprofen is a member and is often used for fever in children)... [more]

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