PPI lansoprazole doesn't help children with poorly controlled asthma if they don't have reflux symptoms (GERD)

Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control. However, it it not clear if treating asymptomatic GERD with proton pump inhibitors (PPI) helps the asthma symptoms.

300 children with asthma with mean age of 11 years were enrolled at 19 US academic clinical centers and were followed up for 6 months.

There were no significant differences in:

- the Asthma Control Questionnaire (ACQ) score (primary outcome),
- FEV1, forced expiratory volume in the first second
- asthma-related quality of life
- asthma exacerbations

Watch the JAMA video report on the study:



Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, lansoprazole did not affect asthma outcomes.

There were slightly more respiratory infections in the PPI group (relative risk, 1.3).

In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, did not improve symptoms or lung function.

The key here may be whether the children with asthma have symptoms of GERD or not. A 2008 study, presented at the annual ACAAI meeting, showed that "in children with both asthma and gastroesophageal reflux disease (GERD), treating the latter can improve the former."



Severe asthma - differential diagnosis and management (click to enlarge the image). Related: Common Asthma-related Comorbidities. Medscape, 2011, (figure) http://j.mp/omHVc6

References:

Lansoprazole for Children With Poorly Controlled Asthma. JAMA. 2012;307(4):373-380. doi: 10.1001/jama.2011.2035

Costs and Perils of Therapeutic Creep: Children, Asthma, and Proton Pump Inhibitors - JAMA editorial.

"Childhood Asthma - JAMA Patient Page" mistakenly skips allergy tests in asthma evaluation but includes CXR (PDF). All children with asthma should undergo allergy testing in order to identify potential allergic triggers (http://goo.gl/tosfJ).