PPIs do not improve morning symptoms in asthma patients with GERD: Study

Asthma often coexists with gastro-oesophageal reflux disease (GERD). The effect of proton pump inhibitors (PPIs) treatment on asthma concomitant with GERD was inconsistent. In a recent meta-analysis conducted at the Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China, researchers found out that proton pump inhibitors therapy did not show a statistically significant improvement on morning peak expiratory flow in asthma patients having gastro-oesophageal reflux disease, neither in subgroup with symptomatic gastro-oesophageal reflux disease nor in subgroup with treatment duration >12 weeks.

The study is published in the Journal of Respiratory Medicine.

Zhoude Zheng and colleagues aimed to assess whether proton pump inhibitors treatment improved morning peak expiratory flow (mPEF) in asthma patients with gastro-oesophageal reflux disease.

Fourteen randomised clinical trials with a total of 2182 participants were included in the study. Overall, proton pump inhibitors versus placebo did not affect morning peak expiratory flow in patients with asthma having gastro-oesophageal reflux disease (weighted mean difference 8.68 L/min, 95% CI −2.02 to 19.37, p=0.11).

Trial sequential analysis (TSA) further confirmed this finding (TSA adjusted 95% CI −1.03 to 22.25). Subgroups analyses based on the percentage of patients with symptomatic gastro-oesophageal reflux disease ≥95%, treatment duration >12 weeks also found no statistically significant benefit on morning peak expiratory flow.

Similarly, analyses of secondary outcomes (evening PEF, forced expiratory volume in 1 s, asthma symptoms score, asthma quality of life score and episodes of asthma exacerbation) did not show significant difference between proton pump inhibitors and placebo.

As a result, the authors concluded that in this meta-analysis, proton pump inhibitors therapy did not show a statistically significant improvement on morning peak expiratory flow in asthma patients having gastro-oesophageal reflux disease, neither in subgroup with symptomatic gastro-oesophageal reflux disease nor in subgroup with treatment duration >12 weeks.

This analysis does not support a recommendation for proton pump inhibitors therapy as empirical treatment in asthma patients with gastro-oesophageal reflux disease, they further inferred.

http://dx.doi.org/10.1136/bmjopen-2020-043860