Acetaminophen and Asthma: A Bad Marriage

A Best Evidence Review

Charles P. Vega, MD; Veena Kulchaiyawat, DO


May 02, 2012

In This Article

Commentary and Clinical Pearls

Clinicians should make an informed choice as to whether to prescribe or recommend acetaminophen in the treatment of children. Dr. McBride suggests avoiding acetaminophen in children with asthma or at increased risk for asthma. Use of ibuprofen seems appropriate because it is a reasonable alternative to acetaminophen.

At the same time, clinicians and parents need to maintain perspective regarding the limitations of the evidence linking asthma and acetaminophen. Billions of doses of acetaminophen are administered to children worldwide, and the great majority of these children will not develop asthma. Previous acetaminophen use alone should not prompt extra testing for airway disease. Instead, clinicians should guide families to make rational choices about these medications.

Clinical Pearls

  1. Acetaminophen is one of the most widely used medications worldwide. Parents may give such drugs as acetaminophen to their children even in the absence of documented fever.


  2. Epidemiologic studies have demonstrated that acetaminophen increases the risk for wheeze and asthma among children, as did one study of adult women.

  3. Systematic reviews confirm a positive relationship between acetaminophen use and the risk for asthma.

  4. Adding acetaminophen to ibuprofen alone for pediatric fever seems to provide little additional benefit.

  5. The current review suggests that acetaminophen should be avoided in children with asthma or at high risk for asthma. Ibuprofen seems to be a safer choice to treat fever and pain among these children.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.