Children given acetaminophen during the
first year of life to reduce fever are more likely to develop
asthma later on, a new study finds.
These children are also more likely to develop rhinoconjunctivitis
and eczema when they reach age 6 to 7, according to the report
in the Sept. 20 issue of The Lancet.
"If this association is causative, it would suggest that
acetaminophen use is a risk factor for asthma and may explain
the asthma has become more common," said lead researcher Dr.
Richard Beasley, from the Medical Research Institute of New
Zealand in Wellington.
Since this study can't definitively say that acetaminophen
is a cause of asthma, its use for children shouldn't be changed,
Beasley added. "Acetaminophen is the preferred drug for relief
of pain and fever in childhood," he said.
Beasley thinks, however, acetaminophen should not be used
routinely for childhood fever, but reserved for high fevers.
"Acetaminophen is still the preferred agent, but the large
amounts of acetaminophen used around the world are unnecessary,"
he said. "Its use should be limited to treat high fevers."
For the study, Beasley's group collected data on 205,487
children from 31 countries around the world. These children
participated in the International Study of Asthma and Allergies
in Childhood.
The researchers found that children who were given acetaminophen
for fever during the first year of life had a 46 percent increased
risk of developing asthma when they were 6 to 7 years old.
In addition, children who were given high doses of acetaminophen
within the past year had a more than three times increased
risk of asthma. Those who were given medium doses had a 61
percent increased risk of developing the condition, Beasley's
team reported.
Acetaminophen use was also associated with an increased risk
of severe asthma of about 22 percent to 38 percent, the researchers
found.
Moreover, acetaminophen increased the risk of eczema by 18
percent and rhinoconjunctivitis by 32 percent. Among children
given high doses of acetaminophen, the risk for eczema almost
doubled, and the risk for rhinoconjunctivitis increased by
almost threefold, Beasley's group found.
Dr. Norman H. Edelman, vice president for health sciences
and professor of medicine at SUNY Stony Brook University in
New York, and spokesman for the American Lung Association,
said the study adds more evidence to acetaminophen's link
to asthma.
"The study is consistent with quite a few others which show
that use of acetaminophen associated with an increased in
the risk for asthma," Edelman said.
Dr. Geoffrey Chupp, an associate professor of medicine and
director of the Yale Asthma Clinic at Yale University School
of Medicine, thinks the association between acetaminophen
and asthma may be a sign of something else.
"Children who are taking acetaminophen may be getting sick
more often and getting more respiratory viruses, and they
are getting asthma for other reasons," Chupp said. "It's not
actually due to the acetaminophen, but acetaminophen happens
to be in the picture, because they get sick all the time."
Another study in the same journal concluded that allergic
or not, allergic rhinitis is a predictor of asthma in adulthood.
In the study, researchers collected data on 6,461 patients
without asthma. After 8.8 years of follow-up, the researchers
found that 3.1 percent of the patients with non-allergenic
rhinitis developed asthma, as did 4 percent of the individuals
with allergic rhinitis. This compared with only 1.1 percent
of the patients without rhinitis who developed asthma.
"This large prospective study provides strong evidence for
an increased risk of asthma in adults with allergic rhinitis,
and to a lesser extent non-allergic rhinitis... Several clinical
trials in asthmatic patients with allergic rhinitis were associated
with a reduction in asthma symptoms. However, only interventional
studies could be used to conclude that the treatment of allergic
rhinitis is effective in reducing the incidence of asthma,"
the authors concluded.
A third study in the journal found adult asthma has its origins
in early childhood.
For the study, researchers from the Arizona Respiratory Center
collected data on 849 infants. After 22 years of follow-up,
181 people had asthma. The researchers found that children
who had wheezing at age 6 or 7 were four times more likely
to develop asthma as adults.
For children whose wheezing persisted, their risk of developing
asthma increased 14 times. Other factors in childhood which
increased the risk of asthma included low airway function
(4.5 times increased risk for asthma) and bronchial responsiveness
(7 times increased risk for asthma).
"In over 70 percent of people with current asthma and 63
percent of those with newly diagnosed asthma at age 22 years,
episodes of wheezing had happened in the first three years
of life or were reported by parents at age 6 years... Our
findings support our previous proposition that most forms
of asthma have their origins in early life, but we now extend
that proposition to asthma diagnosed in early adult life,"
the authors concluded.