Adult asthma and gastro‐oesophageal reflux: the effects of omeprazole therapy on asthma

Background: Epidemiologic and physiologic studies suggest an association between gastroesophageal refl ux disease (GERD) and chronic cough. However, the benefi t of antirefl ux therapy for chronic cough remains unclear, with most relevant trials reporting negative fi ndings. This systematic review aimed to reevaluate the response of chronic cough to antirefl ux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD. Methods: PubMed and Embase systematic searches identifi ed clinical trials reporting cough response to antirefl ux therapy. Datasets were derived from trials that used pH-metry to characterize patients with chronic cough. Results: Nine randomized controlled trials of varied design that treated patients with acid suppression were identifi ed (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs signifi cantly improved cough relative to placebo, albeit only in the arm receiving placebo fi rst. Therapeutic gain in seven datasets was greater in patients with pathologic esophageal acid exposure (range, 12.5%-35.8%) than in those without (range, 0.0%-8.6%), with no overlap between groups. Conclusions: A therapeutic benefi t for acid-suppressive therapy in patients with chronic cough cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, using physiologically timed cough events during refl ux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem. CHEST 2013; 143(3):605-612Abbreviations: GERD 5 gastroesophageal refl ux disease; LPR 5 laryngopharyngeal refl ux; PPI 5 proton pump inhibitor

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“…Attempts were made to contact study authors for additional information needed for full analysis of their data. [12][13][14][15][16] Results…”

Section: Analysis Of Therapeutic Gainmentioning

confidence: 99%

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Kahrilas

Howden

Hughes

et al. 2013

Chest

153

100

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“…Asthma symptoms also correlated with esophageal pH events on 24-h esophageal pH monitoring [11] . Previous studies on the effect of antireflux therapy on asthma have shown inconsistent results [12][13][14][15][16][17][18][19][20][21][22][23][24] . Most of these studies have been done in small groups of patients with different proton-pump inhibitors and were done for short durations of anti-reflux therapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

Sharma

Sharma²,

Daga³

et al. 2007

WJG

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AIM:To study the effect of combined omeprazole (Ome) and domperidone (Dom) therapy on asthma symptoms and pulmonary function in asthmatics with gastroesophageal reflux. METHODS:We selected 198 asthmatics with gastroesophageal reflux diagnosed by 24-h esophageal pH monitoring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk (1:1 double-blind randomization). Spirometry was done at baseline and after 16 wk of treatment. The primary outcome measures were: mean daily daytime and nighttime asthma symptom scores. Mean daily reflux symptom scores, albuterol use as rescue medication (number of puffs), daytime and nighttime peak expiratory flow rate (PEFR), postbronchodilator forced expiratory volume in 1 second (FEV1) and postbronchodilator forced vital capacity (FVC) were secondary outcome measures. RESULTS:Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score (17.4% vs 8.9%), nighttime asthma symptom score (19.6% vs 5.4%), reflux symptom score (8.7% vs 1.6%) and rescue medication use (23.2% vs 3.1%) after antireflux therapy compared to mean change in placebo group (P < 0.001). There was significant improvement in morning PEFR (7.9% vs 0.2%), evening PEFR (9.8% vs 0.5%), FEV1 (11.1% vs 3.78%) and FVC (9.3% vs 1.52%) in the antireflux therapy group compared to placebo on comparing the mean change from baseline after 16 wk (P < 0.01). CONCLUSION:Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medication use, and improving pulmonary function.

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“…There have been many studies dealing with asthma outcome and medical anti-reflux therapy. Field and Sutherland (1998) reviewed the previously published data on medical anti-reflux therapy with H 2 -receptor blockers (H 2 blockers), cimetidine (Goodall et al 1981;Larrain et al 1991) and ranitidine (Harper et al 1987;Nagel et al 1988;Ekstrom et al 1989;Gustaffson et al 1992), and with a proton pump inhibitor (PPI) omeprazole (Ford et al 1994;Meier et al 1994;Harding et al 1996;Teichtahl et al 1996), showing that asthma symptoms were improved. Kiljander (2003) suggested that, in the management of GERD-related asthma, PPIs other than omeprazole should be used at double the standard dose.…”

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confidence: 99%

A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease

Shimizu

Dobashi

Kobayashi³

et al. 2006

Tohoku J. Exp. Med.

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Aspiration of acid to the airway causes airway inflammation, and acid stress to the airway caused by gastroesophageal reflux disease (GERD) has been known as a potential mechanism of deteriorated asthma symptoms. However, the efficacy of the acid suppressive drugs, H 2 -receptor blockers (H 2 blocker) and proton pump inhibitors, on asthma symptoms and pulmonary functions remains controversial. We therefore designed the randomized prospective study to determine the efficacy of an H 2 blocker (roxatidine, 150 mg/day) and a proton pump inhibitor (lansoprazole, 30 mg/day) on asthma symptoms of 30 asthmatic patients with GERD. These patients were divided in the two groups (15 patients for each group) and treated with either roxatidine or lansoprazole. The diagnosis of GERD was established by the method of Los Angeles classification including mucosal minimum change of Grade M and questionnaire for the diagnosis of reflux disease (QUEST) score. The efficacy of acid suppressive drugs was evaluated by peak expiratory flow (PEF), asthma control questionnaire (ACQ) that evaluates the improvement of asthma symptoms, and forced expiratory volume in 1 second (FEV 1.0 ). Lansoprazole, but not roxatidine, significantly improved PEF and ACQ scores ( p < 0.05) with the improved QUEST scores. However, these acid suppressive drugs did not change the pulmonary function of FEV 1.0 in asthmatic patients. In conclusion, treatment with a proton pump inhibitor, lansoprazole, appears to be useful in improvement of asthma symptoms in asthmatic patients with GERD.asthma; gastroesophageal reflux disease; proton pump inhibitor; H 2 -receptor blocker

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Adult asthma and gastro‐oesophageal reflux: the effects of omeprazole therapy on asthma

Abstract: Omeprazole 40 mg daily improved evening PEFR in asthma patients with GOR. However, asthma symptoms, inhaled beta 2-agonist use and histamine bronchial responsiveness did not change.

Cited by 74 publications

References 13 publications

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease

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