Chest
Volume 136, Issue 5, November 2009, Pages 1316-1323
Journal home page for Chest

Original Research
Asthma
Acetaminophen Use and the Risk of Asthma in Children and Adults: A Systematic Review and Metaanalysis

https://doi.org/10.1378/chest.09-0865Get rights and content

Background

Epidemiologic studies have identified an increased risk of asthma with acetaminophen use, but the results have been conflicting. We sought to quantify the association between acetaminophen use and the risk of asthma in children and adults.

Methods

We searched all the major medical databases, including MEDLINE (from 1966 to 2008) and EMBASE (from 1980 to 2008) to identify pertinent articles. All clinical trials and observational studies were considered. For observational studies, we selected those that clearly defined acetaminophen use and asthma diagnosis. Study quality was assessed by two reviewers, and data were extracted into a spreadsheet. A random-effects model was used to combine studies with asthma and wheezing among both children and adults.

Results

Thirteen cross-sectional studies, four cohort studies, and two case-control studies comprising 425,140 subjects were included in the review. The pooled odds ratio (OR) for asthma among subjects using acetaminophen was 1.63 (95% CI, 1.46 to 1.77). The risk of asthma in children among users of acetaminophen in the year prior to asthma diagnosis and within the first year of life was elevated (OR: 1.60 [95% CI, 1.48 to 1.74] and 1.47 [95% CI, 1.36 to 1.56], respectively). Only one study reported the association between high acetaminophen dose and asthma in children (OR, 3.23; 95% CI, 2.9 to 3.6). There was an increase in the risk of asthma and wheezing with prenatal use of acetaminophen (OR: 1.28 [95% CI, 1.16 to 41] and 1.50 [95% CI, 1.10 to 2.05], respectively).

Conclusions

The results of our review are consistent with an increase in the risk of asthma and wheezing in both children and adults exposed to acetaminophen. Future studies are needed to confirm these results.

Section snippets

Materials and Methods

We conducted a systematic review and metaanalysis based on Quality of Reporting of Metaanalyses9 criteria for reporting the results of systematic reviews of randomized controlled trials (RCTs) and the Metaanalysis of Observational Studies in Epidemiology10 criteria for reporting results of systematic reviews of observational studies.

Results

Twenty-four studies7, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 met our inclusion criteria. After carefully reviewing the articles, four studies15, 16, 17, 18 were found to be duplicates and part of the larger International Study of Asthma and Allergies in Childhood (ISAAC).26 One study19 was excluded because it was part of the same study published at a later date.33 Thirteen cross-sectional studies,7, 21, 22, 25, 26, 27, 28, 29, 30, 31, 32, 36,

Discussion

The results of our systematic review indicate an increase in the risk of asthma with acetaminophen use in both adults and children. We also found an increase in the risk of asthma in children with a history of prenatal exposure to acetaminophen. The strength of our review is mainly in the large sample size, the multinational nature of the study participants, and the consistency of the effect in both children and adults.

Confounding bias has been deemed to be one of the reasons for the positive

Acknowledgments

Author contributions: Dr. Etminan contributed to all aspects of this study in addition to providing administrative, technical, and material support and study supervision. Dr. Etminan also has full access to all of the data and has taken responsibility for the integrity and accuracy of the data. Dr. Sadatsafavi contributed to the study concept and design, analysis and interpretation of the data, statistical analysis, and critical revision of the manuscript. Dr. Jafari contributed to the

References (0)

Cited by (0)

Funding/Support: The study was funded by the Vancouver Coastal Health Research Institute.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

View full text