SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

11/8/05

Proton pump inhibitor therapy in asthma with GERD

Summary
Background - There is considerable debate as to how much associated gastro-esophageal reflux disease (GERD) aggravates concomitant persistent asthma (PA). Antacid therapy may reduce G-I symptoms but usually does not benefit the associated PA.

Findings - Littner et al of the VA Healthcare System in Los Angeles , CA carried out a multi-center, double blind, comparison of lansoprozole (LAN), a proton pump inhibitor (PPI), 30 mg b.i.d. vs placebo for 24 weeks in 207 adults with GERD and moderate to severe persistent asthma treated with inhaled corticosteroids.

They found that the change in mean asthma symptom scores or spirometry findings did not differ significantly between those on LAN vs placebo additional therapy. However, the frequency of acute asthma exacerbation and need for rescue treatment with oral corticosteroids was significantly less in those receiving LAN therapy.

Reference
Chest 2005;128:1128-35

Editor's Comments
This study represents another attempt to determine whether the GERD commonly associated with PA plays a pathogenic role in the respiratory problem. The findings suggest that effective PPI therapy (as indicated by normalization of the pH in the distal esophagus) did not lead to a significant reduction in daily manifestations of PA although the frequency of acute asthma exacerbations was decreased in those receiving LAN treatment. Thus, it remains unsettled whether investigation for unsuspected GERD and its treatment are warranted in an attempt to improve treatment of difficult-to-control asthma.

 

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