Acetaminophen vs. Ibuprofen: Which is Safer for Children with Asthma?

Previous research has concluded that acetaminophen (Tylenol) worsens disease activity in children with asthma; however, a new study refutes that finding in The New England Journal of Medicine.

A collaborative team from Boston Children’s Hospital for the National Heart and Lung and Blood Institute’s Asthma Network (AsthmaNet) carried out the Acetaminophen Versus Ibuprofen in Children with Asthma (AVICA) trial. As the name suggests, the analysis compares the use of acetaminophen and ibuprofen (Motrin) — two medications commonly used to treat pain and fever – in children with asthma.

“The toddler age is a wheezy age when kids are developing asthma, but they also get a lot of fevers and colds,” senior investigator Wanda Phipatanakul, MD, MS, from the Division of Allergy and immunology at Boston Children’s Hospital, said in a news release.

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Working with a cohort of 300 children with mild persistent asthma ages 1 to 5, the researchers randomly assigned the families to give the children either acetaminophen or ibuprofen in the case of pain or fever. The team documented the number of asthma exacerbations that resulted in systemic glucocorticoid treatment over the source of 48 weeks.

The number of acetaminophen or ibuprofen doses ranged from 1 to 15, and the median amount was 5.5. Neither medication nor asthma exacerbations significantly differed between the groups — 0.81 and 0.87 per participant in the acetaminophen and ibuprofen groups, respectively. Out of those taking acetaminophen, 49% experienced at least one asthma exacerbation and 21% experienced at least two. Those numbers came in at 47% and 24% for the ibuprofen group. In addition, asthma-control days, albuterol rescue inhaler, unscheduled healthcare utilization for asthma, or adverse events did not drive differences in the medication groups.

“We found no matter how you slice it, there was absolutely no difference between Tylenol and Motrin,” Phipatanakul continued. “Our findings should alleviate the concerns for safety that were based on observational data.”

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