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Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma
Lin-Shien Fu1,2, Che-Chen Lin3, Chia-Yi Wei3
1Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
Insights
Ibuprofen use increases asthma exacerbation risk in young children, especially those with prior severe events. Acetaminophen may be a safer alternative for managing fever in asthmatic children.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Pediatrics
Background:
- Antipyretics like acetaminophen and ibuprofen are common in pediatric care.
- Previous reports suggest potential negative impacts of these drugs on asthma control.
- Confounding factors necessitate careful risk assessment for asthma exacerbation (AE).
Purpose of the Study:
- To evaluate the impact of acetaminophen versus ibuprofen on asthma exacerbations in children.
- To specifically assess risks in asthmatic children with pre-existing risk factors for severe AE.
Main Methods:
- Utilized the 2010 Taiwan National Health Insurance Research Database.
- Identified 983 persistent asthmatic children aged 1-5 years.
- Analyzed AE risk over 52 weeks based on prior severe AE history and antipyretic use (acetaminophen vs. ibuprofen).
Main Results:
- Ibuprofen use was linked to a higher risk of ER visits or hospitalization for AE (OR = 2.10).
- In children with prior severe AE, ibuprofen significantly increased AE risk compared to acetaminophen (OR = 3.28).
- No significant difference in AE risk was observed between the two drugs for children without prior severe AE.
Conclusions:
- Ibuprofen use is associated with increased AE risk in young asthmatic children with a history of severe exacerbations.
- Acetaminophen may be a preferable antipyretic option for this patient group.
- Pediatricians must conduct thorough risk evaluations before prescribing antipyretics to children with asthma.
Background:
Antipyretics are widely prescribed in pediatric practice. Some reports have mentioned that acetaminophen and non-steroid anti-inflammatory drugs may negatively affect asthma control by causing asthma exacerbation (AE). However, many confounding factors can also influence the risks. We assessed the impact of using acetaminophen or ibuprofen on AE in asthmatic children, especially those with strong risk factors.
Methods:
We used the 2010 Taiwan National Health Insurance Research Database and identified 983 children with persistent asthma aged 1-5 years old; among them, 591 used acetaminophen alone and 392 used ibuprofen alone in 2010. Then, we analyzed the risk of AE over 52 weeks in the patients with and without severe AE in the previous year.
Results:
The ibuprofen group had a higher risk of an emergency room (ER) visit or hospitalization for AE (odds ratio (OR) = 2.10, 95% confidence interval (CI) [1.17-3.76], P = 0.01). Among asthmatic children who had severe AE in the previous year, the risk of AE was higher in the ibuprofen group than in the acetaminophen group (OR = 3.28, 95% CI [1.30-8.29], P = 0.01), where as among those who did not, the risks of AE were similar between the acetaminophen and ibuprofen groups (OR = 1.52, 95% CI [0.71-3.25], P = 0.28).
Conclusions:
Among young asthmatic children, use of ibuprofen was associated with a higher risk of AE than acetaminophen, if they had severe AE with ER visit or hospitalization in the previous year. Pediatricians should use antipyretics among children with asthma after a full evaluation of the risk.
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