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Paracetamol is no more likely to exacerbate asthma in children than ibuprofen, shows study

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4558 (Published 18 August 2016) Cite this as: BMJ 2016;354:i4558
  1. Susan Mayor
  1. London

Using paracetamol to treat fever or pain is no more likely than ibuprofen to exacerbate asthma in children with mild persistent asthma, a randomised trial has shown.1

Observational data have previously linked paracetamol and asthma symptoms to decreased lung function, so some doctors have recommended avoiding the drug in children with asthma. But data from randomised trials have been limited.

The new study, reported in the New England Journal of Medicine, randomly assigned 300 young children aged 12-59 months with mild persistent asthma to be treated with either paracetamol suspension (160 mg per 5 mL) or ibuprofen suspension (100 mg per 5 mL) when needed to alleviate fever or pain over the course of 48 weeks. Over this period the children received a median of 5.5 doses (interquartile range 1.0 to 15.0) of either drug.

Results showed no difference in the number of asthma exacerbations—defined as a clinically significant increase in symptoms needing treatment with systemic glucocorticoidsbetween children treated with paracetamol and those given ibuprofen.

Children treated with paracetamol had a mean of 0.81 exacerbations per participant (95% confidence interval 0.65 to 1.02) over 46 weeks of follow-up, and those given ibuprofen had a mean of 0.87 (0.69 to 1.10). The relative rate of exacerbations with paracetamol when compared with ibuprofen was 0.94 (0.69 to 1.28; P=0.67).

Just under half (49%) of the children treated with paracetamol had at least one asthma exacerbation during the study, and 21% had at least two. This compared with 47% and 24%, respectively, in the ibuprofen group.

The two groups also showed no difference in the percentage of days on which the children’s asthma was in control (85.8% with paracetamol v 86.8% with ibuprofen; P=0.5), in their use of a salbutamol rescue inhaler (2.8 and 3.0 inhalations a week; P=0.69), or in unscheduled visits to healthcare facilities for asthma.

“Over the one-year study period we did not find that asthma exacerbations or other markers of asthma-related complications occurred more frequently among children who were randomly assigned to receive paracetamol than among those randomly assigned to ibuprofen,” said the researchers, led by Wanda Phipatanakul, of Harvard Medical School in Boston, USA.

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