A 12‐month follow‐up study on the preventive effect of oral lansoprazole on acute exacerbation of chronic obstructive pulmonary disease

Xiong, Wei; Zhang, Quansan; Zhao, Wei; Ding, Wei; Zhao, Yunfeng

doi:10.1111/iep.12173

Cited by 10 publications

(10 citation statements)

References 21 publications

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“…The significant decline in lung function with PPI and/or H 2 blocker use in this cohort is also likely due to confounding-by-indication. Xiong et al suggested that treatment of GERD with PPI in patients with COPD is associated with delayed deterioration of FEV 1 after 1-year follow-up [ 43 ]. However, several other studies evaluating the efficacy of anti-reflux medications in COPD did not report on the impact of these pharmacologic therapies on lung function [ 12 , 32 , 44 – 46 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort

et al. 2020

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Rationale Gastroesophageal reflux disease (GERD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and has been associated with increased risk of acute exacerbations, hospitalization, emergency room visits, costs, and quality-of-life impairment. However, it remains unclear whether GERD contributes to the progression of COPD as measured by lung function or computed tomography. Objective To determine the impact of GERD on longitudinal changes in lung function and radiographic lung disease in the COPDGene cohort. Methods We evaluated 5728 participants in the COPDGene cohort who completed Phase I (baseline) and Phase II (5-year follow-up) visits. GERD status was based on participant-reported physician diagnoses. We evaluated associations between GERD and annualized changes in lung function [forced expired volume in 1 s (FEV 1 ) and forced vital capacity (FVC)] and quantitative computed tomography (QCT) metrics of airway disease and emphysema using multivariable regression models. These associations were further evaluated in the setting of GERD treatment with proton-pump inhibitors (PPI) and/or histamine-receptor 2 blockers (H 2 blockers). Results GERD was reported by 2101 (36.7%) participants at either Phase I and/or Phase II. GERD was not associated with significant differences in slopes of FEV 1 (difference of − 2.53 mL/year; 95% confidence interval (CI), − 5.43 to 0.37) or FVC (difference of − 3.05 mL/year; 95% CI, − 7.29 to 1.19), but the odds of rapid FEV 1 decline of ≥40 mL/year was higher in those with GERD (adjusted odds ratio (OR) 1.20; 95%CI, 1.07 to 1.35). Participants with GERD had increased progression of QCT-measured air trapping (0.159%/year; 95% CI, 0.054 to 0.264), but not other QCT metrics such as airway wall area/thickness or emphysema. Among those with GERD, use of PPI and/or H 2 blockers was associated with faster decline in FEV 1 (difference of − 6.61 mL/year; 95% CI, − 11.9 to − 1.36) and FVC (difference of − 9.26 mL/year; 95% CI, − 17.2 to − 1.28). Conclusions GERD was associated with faster COPD disease progression as measured by rapid FEV 1 decline and QCT-measured air trapping, but not by slopes of lung function. The magnitude of the differences was clinically small, but given the high prevalence of GERD, further investigation is warranted to understand the potential disease-modifying role of GERD in COPD pathogenesis and progression. Clinical trials registration NCT00608764 .

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Section: Discussionmentioning

confidence: 99%

Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort

et al. 2020

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“…PPIs are mainly prescribed for GERD and the association between GERD and lung diseases has been established although the mechanism of action and causality have not. Accordingly, there has been an interest in the effect of PPI on chronic lung diseases and although results are controversial (Laheij et al, 2004; Filion et al, 2014; Benson et al, 2015; Lee et al, 2015; Othman et al, 2016), PPIs appear to have anti-inflammatory properties in COPD and IPF (Ghebremariam et al, 2015; Xiong et al, 2016). One of the hallmarks of the lung pathophysiology in CF is the chronic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Esomeprazole Increases Airway Surface Liquid pH in Primary Cystic Fibrosis Epithelial Cells

et al. 2018

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Respiratory failure, driven by airways mucus obstruction, chronic inflammation and bacterial infections, is the main cause of mortality and morbidity in people with cystic fibrosis (CF) due to defects in the Cl- and HCO3− transport activity of the CF Transmembrane conductance Regulator (CFTR). Most recent pre-clinical and clinical studies have focused on restoring CFTR function by enhancing its trafficking or transport activity and show promising results. However, there are a significant number of patients that will not benefit from these CFTR-targeted therapies and it is therefore important to identify new non-CFTR targets that will restore lung function, by-passing CFTR dysfunction. The H+/K+-ATPase, ATP12A, has recently been identified as a potential novel target for CF therapies, since its acute inhibition by ouabain was shown to help restore mucus viscosity, mucociliary transport, and antimicrobial activity using in vitro CF airway models, and this effect was linked to an increase in the pH of the airway surface liquid (ASL). Here, we have evaluated the potential therapeutic use of ouabain by investigating the effect of chronically treating fully differentiated CF primary human airway epithelial cells (hAECs) with ouabain, under thin film conditions, resembling the in vivo situation. Our results show that although chronic treatment increased ASL pH, this correlated with a deleterious effect on epithelial integrity as assessed by LDH release, transepithelial electrical resistance, fluorescein flux, and ion transport. Since ATP12A shares approximately 65% identity with the gastric H+/K+-ATPase (ATP4A), we investigated the potential of using clinically approved ATP4A proton pump inhibitors (PPIs) for their ability to restore ASL pH in CF hAECs. We show that, despite not expressing ATP4A transcripts, acute exposure to the PPI esomeprezole, produced changes in intracellular pH that were consistent with the inhibition of H+ secretion, but this response was independent of ATP12A. More importantly, chronic exposure of CF hAECs to esomeprazole alkalinized the ASL without disrupting the epithelial barrier integrity, but this increase in ASL pH was consistent with a decrease in mRNA expression of ATP12A. We conclude that PPIs may offer a new approach to restore ASL pH in CF airways, which is independent of CFTR.

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“…290 Oral lansoprazole has been effective in preventing exacerbations by inhibiting gastric secretion, reducing reflux, and decreasing levels of inflammatory markers in sputum. 291…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

<p>Management of the COPD Patient with Comorbidities: An Experts Recommendation Document</p>

Iglesias¹,

Díez-Manglano²,

García³

et al. 2020

COPD

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Background: Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose: To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods: A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results: A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion: This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.

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A 12‐month follow‐up study on the preventive effect of oral lansoprazole on acute exacerbation of chronic obstructive pulmonary disease

Cited by 10 publications

References 21 publications

Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort

Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort

Esomeprazole Increases Airway Surface Liquid pH in Primary Cystic Fibrosis Epithelial Cells

<p>Management of the COPD Patient with Comorbidities: An Experts Recommendation Document</p>

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