Link between childhood use of acetaminophen and asthma?

[emeleel]

Paracetamol-asthma link worries parents | HEALTH | NEWS | tvnz.co.nz

Paracetamol = acetaminophen

"We can certainly say there is a link between paracetamol use and asthma in a child. What we don't know is the nature of the link and whether it is causal or just a chance association," says Beasley.
Beasley has led the study, involving 200,000 children from 31 countries, published in the world's most prestigious medical journal, The Lancet.
It found a 46% increased risk of a child developing asthma by age six if given paracetamol in the first year of life. That risk was also more than doubled if a child had used it routinely through childhood and tripled if use had been heavy several times per month.


********
Paracetamol use rose sharply in the mid-1980s when child aspirin was deemed less safe. But that rise in popularity has coincided with a surge of child asthma cases worldwide, raising suspicions.
"This may be one of the factors that may be influencing our rates of asthma but I'm certain it's not the only factor," says Asher.

Right now they're saying go ahead and use paracetamol/acetaminophen, but it certainly gives one pause, doesn't it?


Another link:

http://www.theglobeandmail.com/servl..._gam_mostemail

With much trepidation, researchers yesterday revealed that they have found a possible link between the use of the pain medication acetaminophen in early childhood and the later development of asthma, nasal allergies and eczema.

(emphasis mine)

[jgibson2[$]]

What I notice is the increased risk with increased use.

Why does a person regularly give acetaminophen to a kid? Because the child has been sick or injured frequently. Coincidence does not prove causality.

IOW, this may be like the study which initially 'proved' that leaving a nightlight on in your child's room increased the risk that the child would be nearsighted. When the results were reviewed, they found that they had neglected to control for nearsightedness in parents - and nearsightedness is often inherited.

I'd love to know what ELSE is different in children who aren't getting acetaminophen and there really isn't an ethical way to do a controlled study in children to determine whether acetaminophen actually causes asthma or whether acetaminophen use is simply coincidental.

[emeleel]

I know Sean got a good bit of Tylenol as a tyke for teething, which had nothing to do with illness or injury. In fact, I ended up having to switch over to Motrin because the Tylenol stopped being effective.

(And in purely anecdotal fashion, he's the one with allergies.)

You bring up good points about the ethics. Not sure how to study this one and get around them.

[Helen_B[$]]

It would take a very lengthy prospective study, including lots of information about the health status of the individuals in the cohort. I know for my family, looking back, what I thought of as teething pain was probably ear aches, caused by allergies. So, I gave kids a lot of Tylenol, and they had a lot of illness and allergies, and eventually, asthma symptoms. I would definitely like to see this researched more thoroughly.

[pippadaisy[$]]

I'm seeing a lot of messy research lately, and I'm siding with Judy on this one... odds are, if you have a kid with asthma, they get more respiratory infections, leading to fevers, leading to more medication.

[jgibson2[$]]

In addition to knowing how the study was structured, I want to know who paid for it.

Remember all those 'studies' linking artificial sweeteners to cancer -- paid for by big sugar companies?

I want to know who paid for the study.

I want to know how it's structured (generally pretty badly).

I want to know what they looked at - and, more importantly, what they didn't.

One recent bad 'research' I've been handed was by a formula company trying to convince me - and other NICU nurses - that their product is better for babies than breast milk from women who don't take their Omega 3 supplements. Breast milk is OK for babies provided the mom takes their very pricey supplement, or eats the right kind of fish at least 3 times/week.

Worst think about that particular presentation was that the presenter claimed IBCLC certification.

[emeleel]

I haven't listened to it yet, but here's the Lancet's podcast discussion of the study:

http://podcast.thelancet.com/audio/l...0september.mp3

[mjfrombuffalo[$]]

The study written report is available at The Lancet. The summary includes the funders, methods, and findings.

[emeleel]

Thanks, MJ!

[pippadaisy[$]]

And there's the answer...

Glaxo Wellcome New Zealand, the New Zealand Lottery Board, Astra Zeneca New Zealand, and Glaxo Wellcome International Medical Affairs.

Interesting that NZ uses their lottery revenue for medical research, though, isn't it?

[jgibson2[$]]

Also, if I'm reading this correctly, this is probably the LEAST reliable way of collecting information from people -- depending on their memory of what they did in the child's first year of life when the kid is 6 or 7 years old. Mostly useless, I'd say. If they REALLY wanted to know whether acetaminophen has a connection to allergies and asthma later, they should conduct a 6-7 year study sending monthly questionnaires to the parents of several thousand kids. I'd love to read the full text, not just the summary, but that's premium content and costs $$. That would answer my questions about methodology. Having participated in more than a few sucky studies myself, I always want to know HOW they were conducted.

They did a few things right.

1. Over 200K kids involved in the study in many different countries, therefore many different medical centers.

2. Links to current symptoms -- still doesn't prove causality, but that 'dose-dependent' thing is a little concerning.

[pippadaisy[$]]

Can you imagine someone asking ME??? My god... All I can tell you about Buster's first six months is that he cried. And puked. And cried. And DID NOT SLEEP. I don't think he ever closed his eyes. Now ask me how much Tylenol I might have given him.

[mjfrombuffalo[$]]

Hey Pippa, how much Tylenol might you have given him?


(ducks and runs)

[pippadaisy[$]]

MJ, anywhere from absolutely none to a bottle a week. I have that little recall. I'd bet I used acetaminophen over whatever Motrin is that I'm blanking on at the moment, only because the Infant Motrin was more likely to make him barf. Aside from that? All bets are off. And yes, he as asthma. LMAO.

[Helen_B[$]]

jgibson2 said

In addition to knowing how the study was structured, I want to know who paid for it.

One recent bad 'research' I've been handed was by a formula company trying to convince me - and other NICU nurses - that their product is better for babies than breast milk from women who don't take their Omega 3 supplements. Breast milk is OK for babies provided the mom takes their very pricey supplement, or eats the right kind of fish at least 3 times/week.

Worst think about that particular presentation was that the presenter claimed IBCLC certification.

Judy, you should report that person to IBLCE (the International Board of Lactation Consultant Examiners)and to ILCA (the International Latation Consultants Association). That talk was an ethics violation, and the person should be reviewed with an eye to having his/her credentials yanked.

Btw, this wouldn't be the formula with the added fatty acids that cause serious diarrhea in some babies, would it? The fatty acids that were added merely as a marketing ploy, to quote the supplier? I can't believe that a formula company would have the nerve to market a supplement for mothers, so their milk will be able to "compete" with formula. That's unethical too, as far I'm concerned.

[jgibson2[$]]

Helen,
The talk was over a year ago, so I'm not sure I have anything with her name on it any more. I should have thought about contacting IBCLE about her at the time. I was horrified.

This was one of the major formula companies and don't they all add crap so they can advertise? IMHO, not one of them is any better than another in that regard.