Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S34 (doi:10.1542/peds.2006-0900DDD)
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The Prevalence of Ibuprofen-Sensitive Asthma in Children: A Randomized Controlled Bronchoprovocation Challenge Study

John E. Duplantier, MD

Indianapolis, IN

ABSTRACT

PURPOSE OF THE STUDY.: To determine the prevalence of ibuprofen-sensitive asthma in school-aged children with mild or moderate persistent asthma.

STUDY POPULATION.: Children (n = 100) between the ages of 6 and 18 years with a 2-year history of asthma.

METHODS.: Ibuprofen (10 mg/kg) was administered via a randomized, double-blind, placebo-controlled crossover trial. At 0.5, 1, 2, and 4 hours postingestion, spirometry and physical examinations were performed. Children taking leukotriene receptor antagonists or with a known sensitivity to aspirin or ibuprofen sensitivity were excluded.

RESULTS.: Two subjects (2%) had bronchospasm after administration of ibuprofen, with decreases in the forced expiratory volume in 1 second (FEV1) of 35% and 25%, respectively. The maximal drop in FEV1 occurred 1 hour after ibuprofen administration in both subjects. Clinical manifestations of shortness of breath and wheezing on auscultation were noted in both patients. Resolution of symptoms and pulmonary-function values occurred after administration of albuterol. Neither patient had a decrease in FEV1 after placebo. Neither patient had a history of ibuprofen use before study enrollment. Two additional patients had a decrease in FEV1 of 15% (with no change after placebo) but remained asymptomatic with normal physical examinations.

CONCLUSIONS.: In this study of children ages 6 to 18 years with mild or moderate persistent asthma, the prevalence of ibuprofen-induced bronchospasm was 2%. This is much lower than previous estimates (9%–28%) of aspirin-sensitive asthma in children.

REVIEWER COMMENTS.: Use of inhaled corticosteroids by 70% of study subjects and exclusion of patients with severe asthma and those using leukotriene receptor antagonists may have resulted in an underestimate of the prevalence of ibuprofen-sensitive asthma. However, given the widespread use of ibuprofen as an over-the-counter analgesic and antipyretic, pediatricians should be aware of the possibility of ibuprofen-induced asthma exacerbations.

Debley JS, Carter ER, Gibson RL, Rosenfeld M, Redding GJ. J Pediatr. 2005;147:233–238[CrossRef][ISI][Medline]