Acetaminophen Use and the Risk of Asthma in Children and Adults

Etminan, Mahyar; Sadatsafavi, Mohsen; Jafari, Siavash; Doyle-Waters, Mimi; Aminzadeh, Kevin; FitzGerald, J. Mark

doi:10.1378/chest.09-0865

Cited by 123 publications

(102 citation statements)

References 38 publications

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“…Strength of the association [57][58][59] 2. Robustness of association across geography, culture and age [51,[53][54][55][60][61][62][63] 3. Dose-response relationship between acetaminophen exposure and asthma [58,59] 4.…”

Section: Case Study: the Paracetamol Enigma In Asthmamentioning

confidence: 99%

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

Osimani

Mignini

2014

Drug Saf

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It is increasingly acknowledged both among epidemiologists and regulators that the assessment of pharmaceutical harm requires specific methodological approaches that cannot simply duplicate those developed for testing efficacy. However, this intuition lacks sound epistemic bases and delivers ad hoc advice. This paper explains why the same methods of scientific inference do not fare equally well for efficacy and safety assessment by tracing them back to their epistemic foundations. To illustrate this, Cartwright's distinction into clinching and vouching methods is adopted and a series of reasons is provided for preferring the latter to the former: (1) the need to take into account all available knowledge and integrate it with incoming data; (2) the awareness that a latent unknown risk may always change the safety profile of a given drug (precautionary principle); (3) cumulative learning over time; (4) requirement of probabilistic causal assessment to allow decision under uncertainty; (5) impartiality; and (6) limited and local information provided by randomised controlled trials. Subsequently, the clinchers/vouchers distinction is applied to a case study concerning the debated causal association between paracetamol and asthma. This study illustrates the tension between implicit epistemologies adopted in evaluating evidence and causality; furthermore, it also shows that discounting causal evidence may be a result of unacknowledged low priors or lack of valid alternative options. We conclude with a presentation of the changing landscape in pharmacology and the trend towards an increased use of Bayesian tools for assessment of harms. Key PointsCausal assessment and scientific inference in pharmacology: inductivist approaches fare better than hypothetico-deductive ones when dealing with harms

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Section: Case Study: the Paracetamol Enigma In Asthmamentioning

confidence: 99%

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

Osimani

Mignini

2014

Drug Saf

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“…Pediatrics 2011;128: 1181-1185 A growing number of studies have documented such a strong association between acetaminophen exposure and asthma that it is possible that much of the dramatic increase in childhood asthma over the past 30 years has been related to the use of acetaminophen. Although this possibility has been widely acknowledged, [1][2][3][4][5][6] commentators have been reluctant, without a randomized clinical trial, to conclude that acetaminophen causes asthma and, with rare exception, [7][8][9] have not recommended changes in practice. As a pediatric pulmonologist, I am entrusted with the care of many asthmatic children and, at some level, with the respiratory health of all children in my area.…”

mentioning

confidence: 99%

“…19 Furthermore, the metabolism of acetaminophen provides a biologically plausible explanation for causation: depletion in airway mucosal glutathione that could contribute to vulnerability to oxidant stress. 20 Although studies of acetaminophen and asthma have been covered previously in thoughtful reviews 1,2,4-7 and a meta-analysis, 3 little has appeared in the pediatric literature, so this brief review might be helpful in providing the rationale for my recommendation. Studies have addressed 2 hypotheses regarding possible ways that acetaminophen might contribute to the severity or prevalence of asthma.…”

mentioning

confidence: 99%

“…First is the possibility that taking acetaminophen increases airway inflammation in people with asthma or a predisposition to asthma contributing to the severity and frequency of symptoms. Second is the possibility that those exposed to acetaminophen in utero 3,21,22 or in the first year of life might be more likely to develop asthma later in childhood. My decision to discourage acetaminophen use in children with asthma is based on data that support the first of these 2 possibilities.…”

mentioning

confidence: 99%

“…11,16,23,24 Studies published through October 2008 with data on current acetaminophen use and asthma symptoms in children and/or adults have been systematically reviewed. 3 Since that time, 4 additional studies can be identified through a PubMed search of "acetaminophen" (or "paracetamol") and "asthma": 3 of children 10,16,24 and 1 of adults. 25 Here I review the epidemiologic studies in children and adults, some reservations about these epidemiologic data, the 2 prospective trials pertaining to this issue, and the clinical implications of these data and the possible relationship between acetaminophen and the asthma epidemic.…”

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confidence: 99%

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The Association of Acetaminophen and Asthma Prevalence and Severity

McBride

2011

Pediatrics

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The epidemiologic association between acetaminophen use and asthma prevalence and severity in children and adults is well established. A variety of observations suggest that acetaminophen use has contributed to the recent increase in asthma prevalence in children: (1) the strength of the association; (2) the consistency of the association across age, geography, and culture; (3) the dose-response relationship; (4) the timing of increased acetaminophen use and the asthma epidemic; (5) the relationship between per-capita sales of acetaminophen and asthma prevalence across countries; (6) the results of a double-blind trial of ibuprofen and acetaminophen for treatment of fever in asthmatic children; and (7) the biologically plausible mechanism of glutathione depletion in airway mucosa. Until future studies document the safety of this drug, children with asthma or at risk for asthma should avoid the use of acetaminophen.

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Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years

et al. 2020

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Key Points Question Are there differences in the antipyretic, analgesic, and safety profiles of acetaminophen (paracetamol) compared with ibuprofen for the short-term treatment of fever or pain in children younger than 2 years? Findings In this meta-analysis of 19 studies with 241 138 participants, ibuprofen, compared with acetaminophen, was associated with reduced temperature at less than 4 hours and 4 to 24 hours and less pain at 4 to 24 hours. Adverse events were uncommon. Meaning In this study, use of ibuprofen vs acetaminophen for the treatment of fever or pain in children younger than 2 years was associated with reduced temperature and less pain within the first 24 hours of treatment, with equivalent safety.

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Acetaminophen Use and the Risk of Asthma in Children and Adults

Cited by 123 publications

References 38 publications

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

The Association of Acetaminophen and Asthma Prevalence and Severity

Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years

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