Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma.

Lin-Shien Fu,Ching-Heng Lin,Yung-Chieh Huang,Che-Chen Lin,Chia-Yi Wei

doi:10.7717/peerj.6760

Abstract

BackgroundAntipyretics are widely prescribed in pediatric practice. Some reports have mentioned that acetaminophen and non-steroid anti-inflammatory drugs may negatively affect asthma control by causing asthma exacerbation (AE). However, many confounding factors can also influence the risks. We assessed the impact of using acetaminophen or ibuprofen on AE in asthmatic children, especially those with strong risk factors.MethodsWe used the 2010 Taiwan National Health Insurance Research Database and identified 983 children with persistent asthma aged 1–5 years old; among them, 591 used acetaminophen alone and 392 used ibuprofen alone in 2010. Then, we analyzed the risk of AE over 52 weeks in the patients with and without severe AE in the previous year.ResultsThe ibuprofen group had a higher risk of an emergency room (ER) visit or hospitalization for AE (odds ratio (OR) = 2.10, 95% confidence interval (CI) [1.17–3.76], P = 0.01). Among asthmatic children who had severe AE in the previous year, the risk of AE was higher in the ibuprofen group than in the acetaminophen group (OR = 3.28, 95% CI [1.30–8.29], P = 0.01), where as among those who did not, the risks of AE were similar between the acetaminophen and ibuprofen groups (OR = 1.52, 95% CI [0.71–3.25], P = 0.28).ConclusionsAmong young asthmatic children, use of ibuprofen was associated with a higher risk of AE than acetaminophen, if they had severe AE with ER visit or hospitalization in the previous year. Pediatricians should use antipyretics among children with asthma after a full evaluation of the risk.

Highlights

Acetaminophen and ibuprofen are the most widely used medications in children, the major indication of their use being fever
When we further analyzed our results according to the patients’ sex, we found that among female children (Table 3B) with asthma who had an asthma-related emergency room (ER) visit or hospitalization in the previous year, those in the ibuprofen group had a higher risk of asthma exacerbation (AE) than did those in the acetaminophen group
Our study focused on severe AE as indicated by asthma-related ER visits or hospitalization in the previous year, which was not analyzed in previous studies

Summary

Introduction

Acetaminophen and ibuprofen are the most widely used medications in children, the major indication of their use being fever. (Bacharier et al, 2008; Gonzalez-Barcala et al, 2013; Henderson & Shaheen, 2013; Kreiner-Moller et al, 2012; Muc, Padez & Pinto, 2013; Scialli et al, 2010; Shaheen et al, 2000; Thiele et al, 2013; Wong et al, 2007) None of these studies have reported on ibuprofen use, even though it is another frequently used antipyretic. Conclusions: Among young asthmatic children, use of ibuprofen was associated with a higher risk of AE than acetaminophen, if they had severe AE with ER visit or hospitalization in the previous year. Pediatricians should use antipyretics among children with asthma after a full evaluation of the risk

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Results

Discussion

Conclusion