By Dr. Paul Ehrlich
Readers of the New York Times Science section on Tuesday were greeted with a headline, “Studies Suggest an Acetaminophen-Asthma Link”. Wow! If ever an article was written to breed despair and guilt among parents, that was it. The piece tells of a new study in Pediatrics “arguing that the evidence for a link between acetaminophen (aka paracetamol) and asthma is now strong enough for doctors to recommend that infants and children who have asthma (or are at risk for the disease) avoid acetaminophen.”
Briefly, this drug, the active ingredient in Tylenol, has been the go-to anti-inflammatory drug for reducing children’s fevers and pain ever since aspirin was found to increase the risk of a terrible thing called Reye’s Syndrome. The trouble I have with this study is that it reflects another instance of hanging a complex set of symptoms we call asthma on a single hook. Sure the increase of asthma has coincided with the widespread use of Children’s Tylenol and its generic versions. But that same 30 years has also seen issues of air quality, climate change, dietary change, viral disease, excessive use of antibiotics, more “screen time” substituting for outdoor play, and many other factors (see our review of The Allergy Epidemic here). There are plenty of reasons that the kids who take acetaminophen might get more asthma. One is that they might just get sick more often than other children—respiratory viruses causing asthma is a current hot item in research—and, therefore, take more of the stuff.
There is some pretty fancy science here connected to the physiology of inflammation. It does stand to reason that when you suppress the inflammatory response to reduce a fever with a non-steroidal, anti-inflammatory drug there could be some kind of effect on tissue that is susceptible to inflammation, such as the airways. But where does that leave us? If all the parents move away from acetaminophen and on to ibuprofen, the next logical step, are we going to find ourselves in the same spot 30 years from now? Are we prepared to tolerate higher fevers and more teething pain? What will be the long-term health consequences of that?