Acetaminophen and asthma.
Subject: Asthma (Risk factors)
Asthma (Development and progression)
Acetaminophen (Complications and side effects)
Author: Klotter, Jule
Pub Date: 04/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: April, 2012 Source Issue: 345
Product: Product Code: 2834224 Acetaminophen-Based Analgesics NAICS Code: 325412 Pharmaceutical Preparation Manufacturing SIC Code: 2833 Medicinals and botanicals; 2834 Pharmaceutical preparations
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 286257190
Full Text: Acetaminophen, found in over-the-counter pain-and fever-relief products such as Tylenol, contributes to asthma, according to a growing body of research. While current evidence does not prove cause and effect, pediatric pulmonologist John T. McBride is convinced that those with asthma or a family history of asthma should avoid using the drug. Acetaminophen causes thousands of acute liver failure cases each year, according to Jay S. Cohen, MD. N-acetyl-benzoquinoneimine (NABQI), a toxic substance, arises as acetaminophen breaks down in the body. The liver uses up glutathione as it detoxifies this substance. If glutathione levels are low - which is common during fasts of any kind (including illness) and alcohol consumption-NABQI accumulates and damages the liver.

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Glutathione is also present in airway mucus linings, where it helps repair oxidative damage and prevent inflammation. Just one dose of acetaminophen can deplete glutathione levels throughout the body, including the respiratory tract. As a result, wheezing, bronchial constriction, and other signs of asthma arise in people who are predisposed to asthma.

In a Pediatrics article, McBride cites several studies, mostly epidemiological, that link acetaminophen use to increased asthma prevalence and severity. Although epidemiological evidence in itself can never establish cause and effect, McBride comments that the studies have produced consistent results "across age, geography, and culture." In addition, increased acetaminophen use directly corresponds to a rise in asthma prevalence and symptom severity among individuals. For example, the recent International Study of Allergy and Asthma in Childhood (ISAAC) Phase Three epidemiological study, led by R. Beasley, gathered data from 200,000 children, ages 6 to 7 years, and 320,000 children, ages 13 to 14 years. "For 6-to 7-year-olds, the risk of current asthma was increased 1.61-fold (95% confidence interval 1.46-1 J7) for those who took acetaminophen more than once per year but less than once per month and 3.23-fold (95% CI: 2.91-3.60) for those who took acetaminophen at least once per month," McBride reports. "For 13-to 14-year-olds the risks were 1.43 (95% CI: 1.33-1.53) and 2.51 (95% CI: 2.33-2.70), respectively."

McBride also cites a double-blind trial of ibuprofen and acetaminophen for treatment of fever in children, the Boston University Fever Study led by S. M. Lesko. Almost 84,000 children, aged 6 months to 12 years, received low-dose ibuprofen, high-dose ibuprofen, or acetaminophen (12 mg/kg per dose) to take as needed to treat fever. Each group had approximately the same number of children with asthma. "For asthmatic children with a respiratory infection, the subsequent need for an outpatient asthma visit was 2.3 times higher in those treated with acetaminophen (95% CI: 1.26-4.16), and the risk was dose-dependent." McBride writes. Adult studies have also shown associations between acetaminophen use and asthma incidence.

Parents reach for acetaminophen (or ibuprofen), not realizing that fevers actually help their children heal. Sherri Tenpenny, DO, explains in "The Importance of Fever," that elevated body temperature increases the immune response while creating an environment that discourages pathogen reproduction. Suppressing a fever with ibuprofen, acetaminophen, or aspirin increases the time that it takes the body to overcome the infection. "When doctors tell parents to give medication when a temperature rises above a certain level, say 101 F," Tenpenny writes, "many parents automatically assume that a fever is 'dangerous' at that level. The result is to give children drugs to keep them from harm. In reality, the purpose of anti-fever methods is to provide comfort as the body fights off the infection. If doctors were clear about this, there would be a lot less 'fever phobia' around."

Instead of reaching for drugs that suppress a fever, Tenpenny urges doctors to educate parents about more useful ways to make children comfortable and support their healing. Small, frequent sips of water heads the list: "Fever increases iluid loss, and dehydration cause fevers to remain high." Parents should also avoid giving children sugary foods and drinks, such as ice cream and soda pop, because sugar decreases white blood cell activity - the very cells fighting nasty bacteria and viruses. "If the situation does not seem urgent," writes Tenpenny, "consider a trial of echinacea tea, lavender oil, Vitamin D 5,000-50,000/lU day and Vitamin C (10 mg per pound) before ... using fever drugs."

I would also suggest buying a low-potency (30X or 30C) homeopathic home care kit. Having remedies on hand that address a wide variety of common symptoms is a great addition to the home medicine cabinet. Some kits, like the one made by Standard Homeopathic, come with a user-friendly reference guide that makes it easy to match symptoms to remedies. These low-potency homeopathic remedies can do no harm, and it is amazing how much they can help symptoms move on.

Aschwanden C Studies suggest an acetaminophen-asthma link. New York Times. December 19, 2011. Available at www.nytimesxom/2011/12/20/health/evidence-mounts-linking-acetaminophen-and-asthma. Accessed January 6, 2012.

Cohen JS. The little-known dangers of acetaminophen. Life Extension. December 2007;43-49.

McBride jT. The association of acetaminophen and asthma prevalence and severity. Pediatrics. Epub November 7, 2011. http://pediatrics.aapixiblications.org/content/early/2011/11/04/peds.2011-1106-Accessed January 11, 2012.

Tenpenny S. The importance of fever [online article], http://drtenpenny.com/fever.aspx. Accessed January 21, 2012.

briefed by Jule Klotter jule@townsendletter.com
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