A systematic review and meta-analysis examined the association between ibuprofen use and the risk of developing or exacerbating asthma in patients aged 0 to 18 years.
In the study, published in BMC Pulmonary Medicine, investigators included 24 studies of various designs. In 13 studies involving the general pediatric population, a meta-analysis of five randomized controlled trials (RCTs) comparing ibuprofen with active comparators, primarily acetaminophen, over a short duration (≤ 28 days) showed no significant difference in the risk of asthma-related adverse events (odds ratio [OR] = 0.87, 95% confidence interval [CI] = 0.55–1.37). This finding was largely driven by the Boston University Fever Study, a large RCT conducted nearly 30 years ago involving 83,915 patients aged 6 months to 12 years.
One observational cohort study comparing ibuprofen with acetaminophen found no significant difference in wheezing over a short duration (14 days) but observed a significant reduction in health care practitioner visits for wheezing illness consistent with bronchiolitis or asthma over a 1-year follow-up period (adjusted incidence rate ratio [IRR] = 0.82, 95% confidence interval [CI] = 0.70–0.95).
When compared with no alternative drug use, two observational studies in the general pediatric population reported a significant decrease in asthma-related symptoms with short-term ibuprofen use. One cross-sectional study found an adjusted OR of 0.36 (95% CI = 0.13–0.96) for wheezing during the current febrile illness, while a cohort study reported an adjusted IRR of 0.15 (95% CI = 0.14–0.16) for health care practitioner visits for wheezing illness over 14 days.
In five studies involving children with asthma, three studies (two RCTs and one observational study) compared ibuprofen with acetaminophen. One RCT with a short follow-up (28 days) found no significant difference in hospitalizations with asthma (risk ratio [RR] = 0.63, 95% CI = 0.25–1.6). Two studies with long follow-up durations (46 to 52 weeks) yielded conflicting results; however, a tentative synthesis suggested no overall difference between the drugs (OR = 1.24, 95% CI = 0.87–1.77).
One observational cohort study in children with asthma found an increased risk of asthma exacerbation with short-term (1 to 2 days) ibuprofen use compared with no use (adjusted OR = 3.65, 95% CI = 1.98–6.74) but no significant difference over a longer follow-up (> 12 weeks).
In four drug provocation trials involving a total of 80 children with confirmed ibuprofen hypersensitivity, respiratory adverse events, including asthma, coughing, wheezing, dyspnea, and respiratory distress, were reported in 10 children (12.5%) following ibuprofen ingestion.
The systematic review highlighted the need for further research, particularly in pediatric patients with preexisting asthma, to better understand the potential role of ibuprofen in childhood asthma pathogenesis. The investigators noted that the majority of the studies were conducted in the general pediatric population, with limited research in clinically relevant subpopulations and contexts.
The authors declared having no competing interests.
