January 30, 2012

Acetaminophen and lung disease - Is there a link?

Acetaminophen/Tylenol/paracetamol - we use this drug to help with pain, fever or malaise. It was developed in the early 1900's and was brought to market in 1953. It is believed to inhibit the enzyme cyclooxygenase 2 which in turn reduces the production of pro inflammatory chemicals like arachadonic acid,

thereby, providing it's user with relief. It is removed from the body by the liver and also utilizes glutathione for clearance. Our cells need glutathione to detoxify unwanted chemicals in our system. Here is where the rub comes in.

It happens to be the subject of much controversy regarding the asthma epidemic. In a recent Pediatrics article from December 2011, the author, John McBride, a pulmonologist, reviews the data. He sees a plausible mechanism for the hypothesis that asthma is on the rise because of the overuse of Tylenol in young children when they are sick with respiratory viral infections. The acetaminophen is depleting the glutathione in the lungs and reducing the bodies natural toxin clearing mechanism. This makes the child's lung tissue susceptible to the chemical.

I believe that chemicals can alter the cell's DNA at the lung tissue thereby epigenetically inducing asthma. We have seen this model occur with other diseases like diabetes (see Duk Hee Lee's work, Volume 1, letter 2) There is evidence that chemicals believed to cause trouble include air pollution particulate matter, cigarette smoke and other in house aerosolized particles that are synthetic. See www.EWG.org. Proving direct causation is always difficult.

I am not saying that this is the only cause of the asthma epidemic. To the contrary, it is only a likely player in the game along with poor maternal health while pregnant, other drug exposures and poor childhood nutrition.

In his article, he states the obvious. If there is a chance that this drug could be triggering asthma in children, then why are we not discussing it with our patients and counseling them about judicious use.

I still hear it said over and over again to rotate Tylenol and ibuprofen for fever. There is no basis for this recommendation. Now we have another reason to avoid this archaic treatment regimen.

Here is another interesting study:

Leffers, H, et al (2010). "Intrauterine exposure to mild analgesics is a risk factor for development of male reproductive disorders in human and rat". Human Reproduction 25 (1): 235-244.

My take home point today: Use this drug only when you have to.

Just thinking out loud,

Dr. Magryta