[fm]: Giving Tylenol to children with asthma OK, study says

A dozen or so Pittsburgh children with asthma were part of a national study that says it debunks a theory that using acetaminophen makes asthma symptoms worse. In the study reported today in the New England Journal of Medicine, the effects of acetaminophen were equal to those of ibuprofen.

It’s reassuring news for parents, said Deborah Gentile, director of allergy and asthma clinical research for Allegheny Health Network. “Children with asthma have more respiratory infections. There’s probably something about their immune system that when they get sick, it triggers the asthma.”

The National Institutes of Health funded the 18-site randomized double-blind study, which enrolled 300 children ages 12 to 59 months with mild persistent asthma. Half were assigned to take acetaminophen as needed for pain and fever; the other half were to take ibuprofen.

The advice against acetaminophen was not part of established asthma treatment guidelines, but, as one of its authors, Dr. Gentile said the published study is part of a larger effort to set guidelines.

To compare equal groups of children, all participating were taking daily medicines to control their asthma symptoms. Parents and guardians of the children could use their discretion about when to give them the pain and relief medicine.

Local clinics were at Children’s Hospital of Pittsburgh of UPMC and Allegheny General Hospital. Regular clinic visits and unscheduled visits to the clinics, urgent-care centers and doctor’s offices were recorded. Sally Wenzel, director of the University of Pittsburgh Asthma Institute, led the local arm of the study.

Over the 48-week trial, ending April 2015, the primary outcome measured was the number of times the asthma got worse and the children needed treatment with prednisone. Also measured were the percentage of good asthma-control days, the average use of rescue albuterol medicine and the frequency of unscheduled visits for asthma care.

Of the 226 children who completed the trial, the rate of worsened asthma, called exacerbations, “did not differ significantly between the groups,” the study says. Out of that group, the same conclusion was drawn when just counting the 200 children who received the trial medicine at least once. The mean rate of exacerbation during the study was 0.81 (a bit less than one attack for each child during the 48 weeks). 

Asthma-control days for both groups was about 86 percent; rescue albuterol averaged about three inhalations per week and the unscheduled visits for health care were less than one episode per participant.

The study noted its results might not apply to other age groups or to patients with more severe asthma.

Pittsburgh pediatrician Todd Wolynn said he knew about the claims against acetaminophen, but neither he nor his colleagues advised against taking it. He said he would like to see a study on the effects of prenatal acetaminophen use.

“There’s an intriguing Norwegian study” on that topic, he said, citing a February 2016 observational study of 95,000 mothers and 114,000 children. It found associations between prenatal exposure to acetaminophen and asthma at 3 years old.

Pediatric pulmonologist Erick Forno, who sees patients at Children’s Pediatric Asthma Center, said a larger trial might confirm the findings of the NEJM study. “This does give relief to parents. They aren’t giving anything to their children that is going to make their asthma worse. They can feel reassured that giving them Tylenol is OK.”




By: Jill Daly (Pittsburgh Post-Gazette).

Photo: Pinterest.

Review: Emerging Market Formulations & Research Unit, FLAGSHIP RECORDS.

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