Research

Paracetamol use in early life and asthma: prospective birth cohort study

BMJ 2010; 341 doi: 10.1136/bmj.c4616 (Published 15 September 2010)
Cite this as: BMJ 2010;341:c4616
  1. Adrian J Lowe, research fellow12,
  2. John B Carlin, director of Clinical Epidemiology and Biostatistics Unit12,
  3. Catherine M Bennett, associate professor2,
  4. Clifford S Hosking, paediatric allergist3,
  5. Katrina J Allen, paediatric gastroenterologist/allergist1,
  6. Colin F Robertson, respiratory physician1,
  7. Christine Axelrad, research nurse1,
  8. Michael J Abramson, deputy head of department4,
  9. David J Hill, senior consultant allergist1,
  10. Shyamali C Dharmage, principal research fellow12
  1. 1Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Vic 3052, Australia
  2. 2Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Carlton, Vic 3053, Australia
  3. 3Department of Paediatrics, John Hunter Children’s Hospital, New Lambton, Newcastle, NSW 2305, Australia
  4. 4Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Vic 3004, Australia
  1. Correspondence to: A Lowe lowe.adrian{at}gmail.com
  • Accepted 16 July 2010

Abstract

Objective To determine if use of paracetamol in early life is an independent risk factor for childhood asthma.

Design Prospective birth cohort study.

Setting Melbourne Atopy Cohort Study.

Participants 620 children with a family history of allergic disease, with paracetamol use prospectively documented on 18 occasions from birth to 2 years of age, followed until age 7 years.

Main outcome measures The primary outcome was childhood asthma, ascertained by questionnaire at 6 and 7 years. Secondary outcomes were infantile wheeze, allergic rhinitis, eczema, and skin prick test positivity.

Results Paracetamol had been used in 51% (295/575) of children by 12 weeks of age and in 97% (556/575) by 2 years. Between 6 and 7 years, 80% (495/620) were followed up; 30% (148) had current asthma. Increasing frequency of paracetamol use was weakly associated with increased risk of childhood asthma (crude odds ratio 1.18, 95% confidence interval 1.00 to 1.39, per doubling of days of use). However, after adjustment for frequency of respiratory infections, this association essentially disappeared (odds ratio 1.08, 0.91 to 1.29). Paracetamol use for non-respiratory causes was not associated with asthma (crude odds ratio 0.95, 0.81 to 1.12).

Conclusions In children with a family history of allergic diseases, no association was found between early paracetamol use and risk of subsequent allergic disease after adjustment for respiratory infections or when paracetamol use was restricted to non-respiratory tract infections. These findings suggest that early paracetamol use does not increase the risk of asthma.

Footnotes

  • We thank John Thorburn for assistance in recruitment of patients and administrative assistance and the Mercy Hospital Department of Obstetrics for recruitment of participants. We are grateful to the late Richard Sporik, who originally suggested to us that the Melbourne Atopy Cohort Study (MACS) database would be a useful tool to use to approach this question. We thank Anne Balloch for assistance with data management and all of the MACS children and parents for their participation and ongoing support for this study.

  • Contributors: DJH and CSH acquired funding and supervised the study. DJH, CSH, and CA acquired the data. AJL led the analysis and interpretation of data, with support from JBC, SCD, CFR, and CMB. AJL wrote the initial draft of the manuscript, which was critically revised for important intellectual content by all authors. AJL and SCD had full access to the data (including statistical reports and tables) in the study. AJL is the guarantor.

  • Funding: Dairy Australia, CRC for Asthma, and VicHealth supported AJL during his PhD, when the work presented in the manuscript was first developed. AJL, SCD, and KJA are supported by the National Health and Medical Research Council. Nestec, a subsidiary of Nestlé Australia, provided staff funding for the first six years of the study. The funding bodies had no role in the design, analysis, conduct, or reporting of the study. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) DJH has received support from Nestec (a subsidiary of Nestlé Australia) for the submitted work; (2) within the previous 3 years, SCD has received a grant from GlaxoSmithKline for unrelated work, MJA received funding from Reckitt Benckiser for an unrelated research project, CFR is on the GlaxoSmithKline Pediatric Asthma Scientific Board, and MJA is on the GlaxoSmithKline Scientific Advisory Committee for the Australian Asthma Study, and these companies might have an interest in the submitted work; (3) all authors their spouses, partners, or children have no other financial relationships that may be relevant to the submitted work; and (4) all authors have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: The Mercy Hospital research ethics committee, Melbourne, Australia approved the study.

  • Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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