Hamad Medical Corporation, Doha, Qatar.
Research School of Population Health, Australian National University, Acton, ACT, Australia.
BMC Pulm Med. 2020 Mar 23;20(1):72. doi: 10.1186/s12890-020-1102-5.
Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled.
We conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto's odds ratio.
Five RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05; 95%CI 0.76-1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01; 95%CI 0.63-1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84-1.28).
Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding.
对乙酰氨基酚和布洛芬是儿童发热和疼痛管理中最常用的药物。虽然这两种药物的疗效似乎相似，但与不良反应相关的研究结果却相互矛盾。特别是，与布洛芬相比，服用对乙酰氨基酚的儿童出现喘息和哮喘的发生率仍未确定。
我们对比较儿童服用对乙酰氨基酚和布洛芬后喘息和哮喘恶化的随机对照试验（RCT）进行了荟萃分析。我们在五个数据库中进行了全面检索。纳入报告在使用对乙酰氨基酚或布洛芬后婴儿或儿童出现喘息或哮喘恶化病例的 RCT。使用 Peto 的优势比估计汇总效应大小。
纳入了五项包含 85095 名儿童的 RCT 进行分析。汇总估计值（OR 1.05；95%CI 0.76-1.46）显示，接受对乙酰氨基酚与布洛芬的儿童发生哮喘或哮喘恶化的几率没有差异。当分析仅限于检查哮喘恶化或喘息发生率的 RCT 时，汇总估计值仍相似（OR 1.01；95%CI 0.63-1.64）。额外的偏倚调整质量效果敏感性模型得出了相似的结果（RR 1.03；95%CI 0.84-1.28）。
虽然布洛芬和对乙酰氨基酚在儿童哮喘恶化的发生率方面似乎具有相似的耐受性和安全性，但我们建议进行高质量的试验，用不同剂量的布洛芬或对乙酰氨基酚治疗后，明确哮喘结局的定义，并进行更长时间的随访，以得出任何结论性的发现。
