Pediatrician’s stance gains attention

By William K. Alcorn


An Akron Children’s Hospital pediatric physician’s stance that children with asthma should not use medicines containing acetaminophen has drawn national attention.

Common over-the-counter medicines containing acetaminophen include Tylenol, widely used for pain and fever, and other medications used for allergies, colds and congestion.

Dr. John T. McBride, director of the Robert T. Stone MD Respiratory Center at Akron Children’s, does not contend that Tylenol causes asthma. However, he says there is sufficient evidence to say that it exacerbates the condition, particularly in children, by further irritating their lungs.

Dr. McBride expressed his opinion in a paper, “The Association of Acetaminophen and Asthma Prevalence and Severity,” which was published recently in Pediatrics, the official journal of the American Academy of Pediatrics.

The World Health Organization’s website describes asthma as a disease characterized by recurrent attacks of breathlessness and wheezing, a condition caused by inflammation of the air passages in the lungs and affecting the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs.

Dr. McBride describes the disease more simply: “Asthma means you have sensitive lungs.”

He had for several years followed literature pointing to an association between the use of acetaminophen (Tylenol) and asthma, but remained skeptical.

However, when doing research to speak on the subject to a pediatric pulmonary professional organization, he said he was “stunned” at the large body of evidence suggesting the link.

So were his fellow pediatricians, and they urged him to publish his findings.

As a direct result of his conclusions, Dr. McBride, who, along with his partners, also practices at Akron Children’s Mahoning Valley, began, even without a study that proves the link 100 percent, sharing the information with patient families and pediatricians and family doctors.

“The evidence was very persuasive and the solution simple. We are not talking about a life-saving medicine. Until there is absolute proof that acetaminophen is safe for asthmatics, switch to ibuprofen medicines for pain and fever,” he said.

“I now recommend that any child with asthma or a family history of asthma avoid using acetaminophen,” he said.

He noted in his paper that a second theory suggests that those exposed to acetaminophen in the womb or in the first year of life might be more likely to develop asthma later in childhood; indicating that perhaps pregnant women also should not use the drug.

One study cited by Dr. McBride, the “International Study of Allergy and Asthma in Childhood” published in 2008 and in 2010, included more than a half-million children at 122 centers in 54 countries, including the United States. About 200,000 children were age 6 to 7, and some 320,000 were age 13 and 14.

According to the study, in children who took acetaminophen more than once a year but less than once a month, the risk of current asthma was 61 percent higher in those age 6 to 7, and for young children who took acetaminophen more than once per month, the risk of having asthma more than tripled. For older children who took acetaminophen more than once a month, the risk of having asthma increased 2.5 times.

Dr. McBride, who grew up in Lima, Ohio, graduated from the Case Western Reserve University School of Medicine. He did a pediatrics fellowship at Strong Memorial Hospital in Rochester, N.Y., and studied pediatric pulmonary medicine at Children’s Hospital in Boston, Mass., the pediatric teaching hospital of Harvard Medical School. He is a professor of pediatrics at Northeast Ohio Medical University.

Another indication by the body of studies on the link between acetaminophen and asthma is that the entire asthma epidemic, which grew from 1980 and peaked in 1995 and has remained steady since, is related to the use of acetaminophen.

“If you plot in a graph the prevalence of asthma and the amount of Tylenol sold, the lines rise parallel together. I hope acetaminophen is determined to be the cause of asthma because it would be a simple solution to the epidemic,” he said.

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