Department of Paediatrics, University of Oxford, Oxford, UK.
Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito, Ecuador.
BMC Pulm Med. 2024 Aug 26;24(1):412. doi: 10.1186/s12890-024-03179-3.
Ibuprofen is one of the most commonly used analgesic and antipyretic drugs in children. However, its potential causal role in childhood asthma pathogenesis remains uncertain. In this systematic review, we assessed the association between ibuprofen administration in children and the risk of developing or exacerbating asthma.
We searched MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to May 2022, with no language limits; searched relevant reviews; and performed citation searching. We included studies of any design that were primary empirical peer-reviewed publications, where ibuprofen use in children 0-18 years was reported. Screening was performed in duplicate by blinded review. In total, 24 studies met our criteria. Data were extracted according to PRISMA guidelines, and the risk of bias was assessed using RoB2 and NOS tools. Quantitative data were pooled using fixed effect models, and qualitative data were pooled using narrative synthesis. Primary outcomes were asthma or asthma-like symptoms. The results were grouped according to population (general, asthmatic, and ibuprofen-hypersensitive), comparator type (active and non-active) and follow-up duration (short- and long-term).
Comparing ibuprofen with active comparators, there was no evidence of a higher risk associated with ibuprofen over both the short and long term in either the general or asthmatic population. Comparing ibuprofen use with no active alternative over a short-term follow-up, ibuprofen may provide protection against asthma-like symptoms in the general population when used to ease symptoms of fever or bronchiolitis. In contrast, it may cause asthma exacerbation for those with pre-existing asthma. However, in both populations, there were no clear long-term follow-up effects.
Ibuprofen use in children had no elevated risk relative to active comparators. However, use in children with asthma may lead to asthma exacerbation. The results are driven by a very small number of influential studies, and research in several key clinical contexts is limited to single studies. Both clinical trials and observational studies are needed to understand the potential role of ibuprofen in childhood asthma pathogenesis.
布洛芬是儿童最常用的镇痛和退热药物之一。然而，其在儿童哮喘发病机制中的潜在因果作用尚不确定。在这项系统评价中，我们评估了儿童使用布洛芬与发生或加重哮喘风险之间的关系。
我们检索了 MEDLINE、Embase、Cochrane 图书馆、CINAHL、Web of Science 和 Scopus 从建库到 2022 年 5 月的文献，无语言限制；检索了相关综述；并进行了引文检索。我们纳入了任何设计的研究，这些研究是原始的经验性同行评审出版物，其中报告了儿童（0-18 岁）使用布洛芬。通过盲法审查对筛选进行了重复。共有 24 项研究符合我们的标准。根据 PRISMA 指南提取数据，并使用 RoB2 和 NOS 工具评估偏倚风险。使用固定效应模型对定量数据进行汇总，使用叙述性综合对定性数据进行汇总。主要结局是哮喘或哮喘样症状。根据人群（普通人群、哮喘人群和布洛芬超敏人群）、对照类型（活性和非活性）和随访时间（短期和长期）对结果进行分组。
与活性对照相比，在普通人群和哮喘人群中，布洛芬在短期和长期使用时均未显示出与更高风险相关的证据。与短期使用无活性替代物相比，布洛芬可能在缓解发热或细支气管炎症状时为普通人群提供对哮喘样症状的保护作用。相比之下，它可能会导致患有哮喘的人群哮喘恶化。然而，在这两个人群中，都没有明确的长期随访效果。
与活性对照相比，儿童使用布洛芬的风险没有增加。然而，在患有哮喘的儿童中使用可能会导致哮喘恶化。结果受到极少数有影响力的研究的驱动，在几个关键临床环境中的研究仅限于单篇研究。需要进行临床试验和观察性研究，以了解布洛芬在儿童哮喘发病机制中的潜在作用。
