Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux: Ranitidine

In: Asthma

4 Jun 2014

Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux: RanitidineFifteen patients with asthma and GER were treated with ranitidine, 450 mg daily for 7 days in a blinded, crossover, placebo-controlled study with only a 3-day washout period between treatments The treatment period was too short for GER symptoms to improve. No improvements in asthma symptoms, asthma medication use, or PEFR were demonstrated in this small, short-duration study. canadian health mall

Gustafsson et al studied the effects of ranitidine, 300 mg/d for 4 weeks, in children and adolescents with asthma in a double-blind, crossover, placebo-controlled trial with a 2-week washout period between treatment arms. The only positive finding during ranitidine treatment was that the nocturnal asthma symptom score was better in the subjects with GER than in those without GER. Daytime asthma symptom score, PEF, bronchial reactivity, and spirometric values were unchanged.
Ekstrom et al compared ranitidine, 150 mg twice daily for 4 weeks, to placebo in moderate to severe asthmatics with GER in a double-blind, crossover study with a 2-week washout period between treatments. Ranitidine improved GER symptoms and the nocturnal asthma symptom score, and reduced (5-agonist inhaler use. Daytime asthma symptoms, spirometry, PEF, and bronchial reactivity to histamine were unchanged. The authors subdivided their patients into those with and without RARS (cough, shortness of breath, and wheezing). The improvement in reflux symptoms, nocturnal asthma score, and p-agonist inhaler use were confined to the patients who had RARS.
The only study of prokinetic therapy in asthmatics with GER was an open cisapride protocol in children conducted by Tucci et al. The authors intended to treat 27 children with asthma and GER. The 19 children who completed 3 months of therapy experienced an improvement in asthma symptoms and asthma medication use. Pulmonary function was not measured.
Compared with the H2-receptor antagonists, omeprazole has a greater inhibitory effect on gastric acid production. A meta-analysis of studies comparing rates of healing of esophagitis demonstrated that omeprazole had a therapeutic advantage of 35% to 40% over H2-receptor antagonists. The greater healing effect would be expected to have a greater beneficial effect on asthmatics with GER.

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