Published ahead of print on January 7, 2004, doi:10.1164/rccm.200304-596OC Am. J. Respir. Crit. Care Med., Volume 169, Number 7, April 2004, 836-841 A more recent version of this article appeared on April 1, 2004
Submitted on May 2, 2003 Prospective Study of Acetaminophen Use and Newly Diagnosed Asthma among WomenR. Graham Barr1*,1 Medicine, Division of General Medicine, Division of Epidemiology, Columbia University, College of Physicians and Surgeons and Mailman School of Public Health, New York, NY, USA; Medicine, Channing Laboratory, Brigham and Womens Hospital, Boston, MA, USA; Epidemiology, Harvard School of Public Health, Boston, MA, USA, 2 Medicine, Channing Laboratory, Brigham and Womens Hospital, Boston, MA, USA, 3 Medicine, Channing Laboratory, Brigham and Womens Hospital, Boston, MA, USA; Epidemiology, Harvard School of Public Health, Boston, MA, USA, 4 Medicine, Channing Laboratory, Brigham and Womens Hospital, Boston, MA, USA; Environmental Health, Harvard School of Public Health, Boston, MA, USA, 5 Medicine, Channing Laboratory, Brigham and Womens Hospital, Boston, MA, USA; Epidemiology, Harvard School of Public Health, Boston, MA, USA; Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA * To whom correspondence should be addressed. E-mail: rgb9{at}columbia.edu.
Acetaminophen decreases glutathione levels in the lung, which may predispose to oxidative injury and bronchospasm. Acetaminophen use has been associated with asthma in cross-sectional and birth-cohort studies. We hypothesized that acetaminophen use would be associated with newly diagnosed adult-onset asthma in the Nurses Health Study, a prospective cohort study of 121,700 women. Participants were first asked about frequency of acetaminophen use in 1990. Asthma cases were defined as new physician diagnosis of asthma between 1990 and 1996, plus reiteration of the diagnosis and controller medication use. Proportional hazard models included age, race, socioeconomic status, body mass index, smoking, other analgesic use and postmenopausal hormone use. During 352,719 person-years of follow-up, 346 participants reported a new physician diagnosis of asthma meeting diagnostic criteria. Increasing frequency of acetaminophen use was positively associated with newly diagnosed asthma (P-trend = 0.006). The multivariate rate ratio for asthma for participants who took acetaminophen for more than 14 days per month was 1.63 (95% CI 1.11-2.39) compared to non-users. It would be premature to recommend acetaminophen avoidance for patients with asthma, but further research on pulmonary responses to acetaminophen is necessary to confirm or refute these findings and to identify subgroups whose asthma may be modified by acetaminophen. Key words: analgesics, paracetamol, aspirin, anti-inflammatory agents, non-steriodal
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