Short-term ibuprofen treatment and pulmonary function in children with asthma

Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

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“…The intake of ibuprofen can trigger bronchospasm and exacerbate the asthmatic symptoms of children with aspirin-induced asthma [53]. …”

Section: Safety and Tolerability Of Ibuprofenmentioning

confidence: 99%

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Martino

Chiarugi

Boner

et al. 2017

Drugs

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“…One crossover RCT(46) assessed the prevalence of ibuprofen-sensitive asthma in children with mild or moderate persistent asthma using bronchoprovocation challenge and found a prevalence of 2%. Another non-randomised controlled study (52) assessed the impact of short-term ibuprofen treatment on pulmonary function in children with mild to moderate stable asthma and self-reported aspirin allergy. Relative to a healthy control group, the asthmatic group exhibited a drop in FEV1 (forced expiratory volume in the rst second) of 18.85% and an increase in FeNO (fractional exhaled nitric oxide) of 20.76 ppb.…”

Section: Unsynthesised Papersmentioning

confidence: 99%

The association between ibuprofen administration in children and the risk of developing or exacerbating asthma: a systematic review and meta-analysis

Baxter,

Cobo,

Bhatt

et al. 2023

Preprint

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Background Ibuprofen is one of the most commonly used analgesic and antipyretic drugs in children. However, its potential causal role in childhood asthma pathogenesis remains uncertain. In this systematic review, we assessed the association between ibuprofen administration in children and the risk of developing or exacerbating asthma. Methods We searched MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to May 2022, with no language limits; searched relevant reviews; and performed citation searching. We included studies of any design that were primary empirical peer-reviewed publications, where ibuprofen use in children 0–18 years was reported. Screening was performed in duplicate by blinded review. In total, 24 studies met our criteria. Data were extracted according to PRISMA guidelines, and the risk of bias was assessed using RoB2 and NOS tools. Quantitative data were pooled using fixed effect models, and qualitative data were pooled using narrative synthesis. Primary outcomes were asthma or asthma-like symptoms. The results were grouped according to population (general, asthmatic, and ibuprofen-hypersensitive), comparator type (active and non-active) and follow-up duration (short- and long-term). Results Comparing ibuprofen with active comparators, there was no evidence of a higher risk associated with ibuprofen over both the short and long term in either the general or asthmatic population. Comparing ibuprofen use with no active alternative over a short-term follow-up, ibuprofen may provide protection against asthma-like symptoms in the general population when used to ease symptoms of fever or bronchiolitis. In contrast, it may cause asthma exacerbation for those with pre-existing asthma. However, in both populations, there were no clear long-term follow-up effects. Conclusions Ibuprofen use in children had no elevated risk relative to active comparators. However, use in children with asthma may lead to asthma exacerbation. The results are driven by a very small number of influential studies, and research in several key clinical contexts is limited to single studies. Both clinical trials and observational studies are needed to understand the potential role of ibuprofen in childhood asthma pathogenesis.

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“…Прийом ібупрофену може викликати бронхоспазм і загострення захворювання в дітей з аспіриновою астмою [1,54]. У рандомізованому контрольованому подвійному сліпому дослідженні за участю 100 дітей (середній вік -11 років) тільки два пацієнти відповідали критеріям астми, чутливої до ібупрофену, що призвело до поширеності 2 % [55].…”

Section: бронхіальна астмаunclassified

Clinical safety of ibuprofen in pediatric practice

Borysovа¹

2022

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The article presents a review of the literature on the side effects of ibuprofen in children. The international guidelines recommend ibuprofen as an antipyretic and analgesic drug in pediatrics. The drug is characterized by a high profile of efficacy and safety in the treatment of children with fever, mild to moderate pain. Ibuprofen in over-the-counter doses has a low probability of serious side effects from the gastrointestinal tract and kidneys. Side effects of ibuprofen are transient and resolve after discontinuation of treatment. Circumstances associated with a higher risk of adverse events are highlighted. The use of ibuprofen is contraindicated in children with dehydration, which is associated with a risk of acute kidney damage. Caution should be exercised when prescribing ibuprofen to children with community-acquired pneumonia due to the risk of purulent complications. Ibuprofen should not be prescribed to patients with chickenpox to avoid bacterial superinfections. Ibuprofen should be used with caution in children with diseases of the gastrointestinal tract, liver, renal failure, hemorrhagic syndrome, anticoagulant therapy. Ibuprofen is allowed in children with bronchial asthma unless a personal or family history of aspirin-induced asthma. Caution should be exercised when treating premature infants or low birth weight infants due to the reduction in nephron mass and, therefore, the increased risk of renal damage. Ibuprofen should not be used in patients who are sensitive to this drug or other non-steroidal anti-inflammatory drugs. Ibuprofen should be taken in the minimum effective dose and discontinued as soon as possible — no more than 3 days for fever and 5 days for pain.

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Short-term ibuprofen treatment and pulmonary function in children with asthma

Abstract: The results showed that cross-reactive non-steroidal anti-inflammatory drug hypersensitivity may exist between ibuprofen and aspirin. This raises the possibility that asthma exacerbation could be mediated by ibuprofen ingestion.

Cited by 5 publications

References 12 publications

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

The association between ibuprofen administration in children and the risk of developing or exacerbating asthma: a systematic review and meta-analysis

Clinical safety of ibuprofen in pediatric practice

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