In: Asthma31 May 2014
The MEDLINE database was used to identify studies published from 1966 to 1996 on the effects of medical antireflux therapy in asthma. The term asthma was combined with gastroesophageal reflux. Using the MEDLINE database, asthma was also combined with antacids, alginates, cimetidine, ranitidine, famotidine, nizatidine, cisapride, omeprazole, lansoprazole, pan-toprazole, domperidone, and metoclopramide to insure that we identified all published English-language reports of medical antireflux therapy in asthma. The reference lists of these papers were reviewed to identify additional studies of medical antireflux therapy in asthma.
The identified studies were weighted on the basis of the quality of their design and the number of subjects studied. Using Sackett’s criteria, studies were designated as grade A, B, or C. Group A studies are relatively large, blinded, randomized, placebo-controlled studies; group B studies are smaller, randomized, placebo-controlled studies; and group C studies are uncontrolled. The analysis was limited to the eight randomized, placebo-controlled studies published in the English-language, peer-reviewed literature.
A total of 242 papers were identified, 171 of which were published in English. Among these were 38 reviews, 15 editorials, and 20 letters. One letter reporting exacerbation of brittle asthma with cisapride and one report of a patient whose asthma improved with omeprazole after treatment with a combination of ranitidine and domperidone failed were not included in the analysis. canadianfamilypharmacy
Surprisingly, only 12 studies of antireflux medication in asthmatics with GER have been published in the English-language, peer-reviewed literature (Table 1). Another study was published only as an abstract and does not contain enough information to properly assess the study. One other paper anecdotally reported that antireflux treatment improved asthma control in patients with GER, but did not include any data. Trials of alginates, H2-receptor blockers including cimetidine’ and ranitidine, cisapride, and omeprazole have been conducted to test the effects of antireflux therapy in patients with GER and asthma. All of the identified studies are presented below.
Table 1—Grade Assignment of Published Trials of Medical Antireflux Therapy
|Reference||Therapy||Duration||Design||No. of Subjects||Grade*|
|Kjellen et al||Conservative||2 mo||R,UTC||62||C|
|Goodall et al||Cimetidine, 1 g/d||6 wk||R,C,PC||18||B|
|Larrain et al||Cimetidine, 1.2 g/d||6 mo||R,P,PC||55||B|
|Nagel et al||Ranitidine, 450 mg/d||7 d||R,C,PC||15||B|
|Gustafsson et al||Ranitidine, 300 mg/d||4 wk||R,C,PC||18||B|
|Ekstrom et al||Ranitidine, 300 mg/d||4 wk||R,C,PC||48||B|
|Harper et al||Ranitidine, 300 mg/d||8 wk||Open||15||C|
|Tucci et al||Cisapride, 0.2 mg/kg qid||3 mo||Open||19||C|
|Ford et al||Omeprazole, 20 mg/d||4 wk||R,C,PC||11||B|
|Meier et al||Omeprazole, 40 mg/d||6 wk||R,C,PC||14||B|
|Harding et al||Omeprazole, 20-60 mg/d||3 mo||Open||30||C|
|Teichtahl et al||Omeprazole, 40 mg/d||4 wk||R,C,PC||20||B|
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