Pain, fever medical supplies do not worsen children’s asthma

Medical supplies for pain and fever, such as acetaminophen or ibuprofen, do not make asthma worse in children. The findings of a new (and so far only) blinded, randomized, controlled trial from the Boston Children's Hospital for the National Heart, Lung and Blood Institute's Asthma Network fly in the face of previous studies, which appeared to suggest that giving children acetaminophen for pain or fever would intensify their asthma. “We found no matter how you slice it, there was absolutely no difference between Tylenol (acetaminophen) and Motrin (ibuprofen),” senior investigator and corresponding author Dr. Wanda Phipatanakul of Boston Children's Hospital's Division of Allergy and Immunology said. “Our findings should alleviate the concerns for safety that were based on observational data.”

The Acetaminophen Versus Ibuprofen in Children with Asthma (AVICA) trial divided 300 children aged 1-5 with mild persistent asthma into two groups. Both groups were administered daily inhaled glucocorticoids, as needed inhaled glucocorticoids, and daily oral leukotriene receptor antagonist for asthma, but their families were randomized to use medical supplies for pain and fever – either acetaminophen or ibuprofen – as indicated across a period of 48 weeks. About 75% (226) of the original 300 children finished the study (the trial was admittedly small, yet better equipped to find any clinically significant differences than previous studies, which were not randomized).

The researchers found that the number of asthma aggravations per child averaged .81 in the acetaminophen group and .87 in the ibuprofen group; at least one asthma exacerbation episode took place in 49% of the acetaminophen group as opposed to 47% of the ibuprofen group, while at least two episodes occurred in 21% and 24%, respectively; the percentage of days with full asthma control were about the same for both groups (85.8% and 86.8%, respectively; use of ‘rescue’ medication was practically the same (2.8 compared to 3.0 puffs per week); unscheduled doctor visits for asthma averaged 0.75 versus 0.76 episodes per child. In other words, “there was no difference that would cause me to be alarmed,” as Phipatanakul put it.

Many children aged 12 and younger develop asthma as well as experience a great deal of fever and colds, placing medical supplies like acetaminophen among the most used pediatric over-the-counter medicines in the U.S. “Caregivers of young children who are receiving treatment with asthma-controller medications may be reassured by this result that the use of acetaminophen in usual, as-needed doses will not worsen asthma symptoms in their children and that acetaminophen and ibuprofen can be used similarly in situations for which they are indicated,” Dr. Augusto A. Litonjua from Brigham and Women's Hospital and Harvard Medical School in Boston wrote in an editorial that accompanied the study, which was published in the New England Journal of Medicine.