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http://pediatrics.aappublications.org/content/early/2011/11/04/peds.2011-1106.full.pdf
Is this for real?
I am wondering if this has come up for anyone in their practice. Have you ever recommended not giving Tylenol to a child with a fever because of their asthma? Does this ever come up for adults?
I've never recommended against acetaminophen due to asthma, but the author is correct in stating there is some possible evidence for an association between acetaminophen use and exacerbation of reactive airway disease in these retrospective cohorts. The recommendation to use ibuprofen as an alternative is reasonable, however, it should simply be recognized that like acetaminophen its use probably also has some small, previously undetected adverse effect, as well. The ideal strategy is to minimize the importance of treating fever in children, thereby avoiding any medication issues.
It would be difficult to fault practice in which it were recommended that patients with RAD avoid acetaminophen.
Association /= causality. The author is over-reaching in their recommendations. Everything he's saying may be true, but to go from retrospective cohort data to banning tylenol in asthmatic or at-risk for asthma kids is too broad a leap.
I've never recommended against acetaminophen due to asthma, but the author is correct in stating there is some possible evidence for an association between acetaminophen use and exacerbation of reactive airway disease in these retrospective cohorts. The recommendation to use ibuprofen as an alternative is reasonable, however, it should simply be recognized that like acetaminophen its use probably also has some small, previously undetected adverse effect, as well. The ideal strategy is to minimize the importance of treating fever in children, thereby avoiding any medication issues.
It would be difficult to fault practice in which it were recommended that patients with RAD avoid acetaminophen.
I The ideal strategy is to minimize the importance of treating fever in children, thereby avoiding any medication issues.
I've never recommended against acetaminophen due to asthma, but the author is correct in stating there is some possible evidence for an association between acetaminophen use and exacerbation of reactive airway disease in these retrospective cohorts. The recommendation to use ibuprofen as an alternative is reasonable, however, it should simply be recognized that like acetaminophen its use probably also has some small, previously undetected adverse effect, as well. The ideal strategy is to minimize the importance of treating fever in children, thereby avoiding any medication issues.
It would be difficult to fault practice in which it were recommended that patients with RAD avoid acetaminophen.
The ideal strategy must be to minimize the importance of treating fever while not minimizing the importance of treating symptoms which result in too many kids in the ED...
An unnecessary ED visit (and all that goes into it including testing and medications and exposures) is far worse than a little APAP...
HH
"minimize the importance of treating a fever"...but then what would the nurses harp about?
You guys (both academic types) - could you build up something on this? I mean, I keep reading it, and I am thinking about how I could try to do this, and I am coming up empty. I am thinking what I would say, and nada - bupkus. Throw me a bone here.
The point is to treat them if miserable. Otherwise, don't worry about it. Just like hypertension.
The point is to treat them if miserable. Otherwise, don't worry about it. Just like hypertension.
Because they weren't seizing or suffering heat stroke. I give the "you don't have to treat fever" talk to parents of almost every child with fever.
But has nursing already given the patient an antipyretic?
I am asking a legitimate question. I am not trolling. If people can't give a logical reason for it, I am not going to be a convert. All it takes is one kid to have a febrile seizure, after I said that you don't have to treat fever, and I am forever and ever and ever going to recommend and order antipyretics. As it is, I haven't heard anything persuasive. I have given the "you don't have to treat fever" talk, but I have never dissuaded a caregiver from giving any Tylenol or ibuprofen. There is a difference.
You have responded, after a sort, so, thank you, but I would hope that the others that have advocated would clarify their statements.
Giving antipyretics won't prevent a febrile seizure
That is an interesting way to word it, and it gave me pause.
From a lay public information sheet from NINDS, "If a child has a fever most parents will use fever-lowering drugs such as acetominophen or ibuprofen to make the child more comfortable, although there are no studies that prove that this will reduce the risk of a seizure." "No studies to prove" and "won't prevent" are quite separate. You are saying that a formerly febrile, now euthermic, patient that seizes is one that you are comfortable in "treating and streeting"?
And, I promise you, that WILL cloud the waters for many practitioners if the sequence is as follows: fever --> antipyretic --> defervescence --> seizure.
I've found kiddos tolerate motrin better anyway prolly cause of the taste avoids the whole issue altogether.
until it worsens their bronchospasm....