Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma

Lin-Shien Fu; Che-Chen Lin; Chia-Yi Wei; Ching-Heng Lin; Yung-Chieh Huang

doi:10.7717/peerj.6760

Risk of acute exacerbation between acetaminophen and ibuprofen in children with asthma

PeerJ. 2019 Apr 16:7:e6760. doi: 10.7717/peerj.6760. eCollection 2019.

Authors

Lin-Shien Fu^{1

2}, Che-Chen Lin³, Chia-Yi Wei³, Ching-Heng Lin³, Yung-Chieh Huang^{1

4}

Affiliations

¹ Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan.
³ Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Division of Pediatrics, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan.

Abstract

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.

Keywords: Acetaminophen; Acute exacerbation; Asthma; Ibuprofen; NHIRD; Taiwan.

Grants and funding

This study was supported by grants from Taichung Veterans General Hospital, Taiwan (TCVGH-NHRI10603, TCVGH-1067310C, TCVGH-FCU1068205, TCVGH-YM1060201, TCVGH-VTA106PREM1, TCVGH-1076504B). There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.