Paracetamol Use in Infancy and Risk of Asthma in Children Aged 6 to 7 Years:

[Morphey]

Доброго времени суток коллеги, в журнале Ланцет, появилась любопытная статья, о возможной связи приема парацетамола у детей до года и развитием астмы, риноконюктивита и экземы в более позднем возрасте.

Paracetamol Use in Infancy and Risk of Asthma in Children Aged 6 to 7 Years: Presented at ERS

By Chris Berrie

BERLIN -- October 8, 2008 -- The reported use of paracetamol (acetaminophen) in the first year of life is associated with increases in reported symptoms of asthma and risk of severe asthma symptoms in children aged 6 to 7 years, according to analysis of data from the multicentre, multicountry, cross-sectional International Study of Asthma and Allergies in Children (ISAAC).
The study also found an association between use of paracetamol in childhood and an increased risk of symptoms of rhinoconjunctivitis and eczema in childhood, said principal investigator Richard Beasley, MD, Medical Research Institute of New Zealand, Wellington, New Zealand. The increased international use of paracetamol over the last 40 years occurred contemporaneously with an increased prevalence of asthma, Dr. Beasley said during a presentation on October 7 at the European Respiratory Society (ERS) 18th Annual Congress."

[This study] was based on a hypothesis that was raised 10 years ago, where it was proposed that the switch from aspirin to paracetamol in childhood may have contributed to the increase in asthma prevalence that was noted in many countries in the 1980s," he said.
Therefore, Dr. Beasley and colleagues conducted a study to investigate the association between paracetamol use in infancy and self-reported symptoms of asthma in children aged 6 to 7 years participating in the ISAAC program, which was formed in 1991 to facilitate research into asthma, allergic rhinitis, and eczema.
Data were obtained from 2 groups (children aged 6 to 7 and 13 to 14) from random samples of schools in defined geographical areas worldwide. Samples were collected using 2 simple standardised questionnaires that were completed by the children's parents or guardians.
The prevalence questionnaire obtained data regarding symptoms of asthma, rhinoconjunctivitis, and eczema in these children, while the environmental questionnaire obtained data on a wide range of putative protective and risk factors for asthma and allergic disorders, including paracetamol use for fever in the first year of life.
A total of 194,555 children from 69 centres in 29 countries were included in the analysis, with the multivariate analysis based on 105,041 of these children with complete covariance data. This multivariate analysis of the associations with paracetamol use showed significant odds ratios (ORs) as follows: asthma, 1.46 (95% confidence interval [CI], 1.36-1.56); rhinoconjunctivitis, 1.48 (95% CI, 1.38-1.60); and eczema, 1.35 (95% CI, 1.26-1.45).
When severe asthma symptoms were defined as wheezing causing sleep disturbance or limiting speech, or 4 or more attacks of wheezing in the past 12 months, a similar significant association was seen at the multivariate level for the use of paracetamol (OR, 1.43; 95% CI, 1.30-1.58).
Dr. Beasley noted, "While paracetamol has been shown to be safer than the alternatives and is the recommended treatment ... what we found in this study was that there was a very widespread use of paracetamol beyond its indication for relief of high fever."Indeed, as he stressed, "What we need now is randomised controlled trials to really sort this out properly, and from these trials, there will be the basis for making firm guidelines in terms of management."

The study was published in The Lancet in September 2008 (Beasley R et al. 2008;372:1039-1048).[Presentation title: Paracetamol Use in Infancy and Risk of Asthma in 6-to-7-Year-Old Children: ISAAC Phase Three. Abstract P3777]

[POLINA_S]

И что теперь давать при температуре?

[Morphey]

Парацетамол))). Это не противопоказание, а лишь предупреждение, что чрезмерное использование, даже такого безопаснейшего лекраства, может иметь свои последствия.

[blanka]

Все равно парацетамол останется препаратом выбора. Ну еще ибупрофен. Про него не проводились исследования?
Большинство детей получают парацетамол на первом году жизни. Да, часть из них реализует аллергические состояния в дальнейшем. Но сколько не реализует? Действительно наблюдается увеличение количества детей с проявлениями данных заболеваний. Но, с другой стороны, состояние окружающей среды и увеличение аллергизирующих компонентов тоже не стоят на месте.
Например, во Вьетнаме я вижу гораздо больше детей, чем в России с проявлениями (далеко неоднократными) астматических бронхитов, начиная с 6ти месяцев. Астму, как в России, здесь ставят редко. До 6-ти лет - практически не ставят. Зато 80% населения страны страдают аскаридозом. После дачи антигельминтных препаратов, количество приступов у детей сходит на нет. Практически все они получали парацетамол. Куча anti-cold препаратов, куда он входит в состав, а родители даже об этом и не подозревают. Вот и установи тут связь.... Кто-то будет "раскручивать" парацетамол, кто-то аскарид.

[AlexGold]

[Ссылки доступны только зарегистрированным пользователям ]

Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking.

As part of a multicentric case–control study organised by the Global Allergy and Asthma European Network (GA2LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20–45 yrs) and place of residence.

In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma.

These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.

Следует отметить, что в данном исследовании изучался эффект частого (еженедельного) применения парацетамола у взрослых.

[AlexGold]

Спасибо! А fulltext нету?

Есть. Можно сбросить мне в личку e-mail, я пришлю (правда, к сожалению, смогу это сделать только в конце следующей недели).

[FRSM]

Как всегда, в догонку. 18 сентября, NHS News:

This case-control study has some limitations and the researchers acknowledge the following:

The study did not distinguish between people who never took paracetamol and those who took it less than once a week. As most people took paracetamol less than once a week (over 90%), the researchers collapsed the top four dose categories into one, which then became ‘more than once a week’. These two points mean that they were unable to investigate any dose response, such as whether taking a greater quantity of paracetamol was linked more often to asthma.
As mentioned above, few people took paracetamol more than once a week (only 9% of participants). This small sample size limits the confidence that can be had in the accuracy of the results.
The participants were asked if they took other analgesics, but not how often they took them. This limits the value of information about these drugs.
The researchers cannot rule out that some unmeasured factor may be responsible for the difference between the two groups.
There are two important points to highlight in relation to case-control study designs:

A case-control study cannot prove causation. Although the researchers say that it is unlikely that having asthma led to an increase in paracetamol use, this cannot be ruled out by this study design. Given that asthma is linked with atopy and that atopy may be linked with headaches, people with allergies may indeed be more likely to take painkillers. However, the researchers say that other studies have suggested that this is not the case.
Given the large number of people who have asthma, it is surprising that only 521 people in this 20-45 age group volunteered for what was an international study. This raises the possibility that those who put themselves forward for this trial may differ from the usual person with asthma or from the controls in some way other than their asthma. This sort of methodological difficulty with a trial can only be resolved by randomisation, as the authors recommend.
Reporting bias is also an issue. The researchers relied on participants’ recall of asthma symptoms in the previous 12 months and also relied on their report of how many painkillers were taken each week.
This study suggests that there may be a link between frequent use of paracetamol and symptoms of asthma. This is not a new concern, and researchers from the Imperial College have been investigating this for some time. However, there are problems with this study design that cannot rule out reverse causation, in other words, that having asthma causes people to take more painkillers.

As the researchers conclude, ‘there is now a need to carry out suitable intervention studies to determine whether the link is causal’. Prospective studies, preferably those that randomise healthy participants to paracetamol or not, will produce more conclusive results.