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Acetaminophen May Be Linked to Asthma Risk

Study Shows Painkiller Raises Risk of Asthma; Manufacturer Says Drug Is Safe

Drugmaker's Perspective

In a prepared statement, McNeil Consumer Healthcare, which makes Tylenol, says:

"TYLENOL® (acetaminophen) has over 50 years of clinical history to support its safety and efficacy and, when used as labeled, TYLENOL® has a superior safety profile compared with many other over-the-counter (OTC) pain relievers.  The well-documented safety profile for acetaminophen makes it the preferred pain reliever for asthma sufferers."

The statement continues: "There are no prospective, randomized controlled studies that show a causal link between acetaminophen and asthma. The systematic review and meta-analysis published in Chest does not establish a definitive casual relationship between the therapeutic use of acetaminophen and an increased risk of asthma and wheezing in both children and adults. In fact, the study investigators admit that their systematic review is subject to several limitations, one of which is that diagnosis of asthma in most of the studies was through self-reporting and the possibility of misclassification of asthma with other respiratory conditions can't be excluded. The authors also stated that additional studies would be needed in order to verify their findings.''

Second Opinion

Another expert said the review is strong. "This is clearly synthesizing the studies that have been conducted over the past 10 years and is showing the emerging evidence that acetaminophen seems to be associated with the development of asthma and asthma-like symptoms in children and adults," says Matt Perzanowski, PhD, assistant professor of environmental health sciences at the Mailman School of Public Health at Columbia University in New York.

With his colleagues at Columbia, Perzanowski recently found that prenatal acetaminophen exposure boosts the risk of wheezing in inner city, minority children (who have high rates of asthma) at age 5.

They believe that children with a genetic mutation affecting an antioxidant that helps ''detox'' the body may be the ones at risk, Perzanowski tells WebMD.

A practicing allergist, Rebecca G. Piltch, MD, who cares for patients with asthma and allergies in Marin County, Calif., says the association is interesting but points out it does not prove cause and effect.

Perzanowski agrees, saying: "There is still a possibility the association is due to some other mechanism besides the acetaminophen."

Until more research is done, what's a parent or adult to do? "The American Academy of Pediatrics recommends acetaminophen as the drug of choice for controlling fever," Etminan says. "Parents should still follow these guidelines until the recommendations change."

"For adults, ibuprofen is an alternative drug that can be used," he says. "Unlike acetaminophen, ibuprofen has not been shown to be associated with asthma."

Following the recommended dose is important, he says. The question of whether a specific dose is linked with the risk of asthma needs to be studied, Etminan says.

Patients already diagnosed with asthma should check with their own doctor about acetaminophen use, Piltch says. Those who don't have asthma ''but have concerns about acetaminophen should discuss them with their primary care provider."

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