Abstract
BackgroundParacetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled.MethodsWe conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio.ResultsFive RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05; 95%CI 0.76–1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01; 95%CI 0.63–1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84–1.28).ConclusionAlthough, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding.
Highlights
Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children
A meta-analysis found the odds of wheezing doubles in children exposed to paracetamol [9]
They reported that ibuprofen and paracetamol had similar rates of adverse events; they did not assess the risk of asthma [14]
Summary
Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. Paracetamol is perceived as a safe medication to control pain and fever in children, yet evidence from multiple epidemiological studies have shown a potential association between its use and asthma. The increasing evidence accumulated over the past 30 years about the risk of asthma exacerbations associated with paracetamol has led clinicians to recommend a change in practice, in children [11,12,13]. A meta-analysis by Pierce and Voss found that ibuprofen is more effective in reducing pain and fever than paracetamol in paediatric population [14]. They reported that ibuprofen and paracetamol had similar rates of adverse events; they did not assess the risk of asthma [14]. The inhibition of the COX pathway can activate the lipoxygenase pathway, leading to an increase in leukotriene synthesis, and resulting in bronchospasms and asthma exacerbation [15]
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