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

In: Asthma

6 Jun 2014

Ford et al studied the effects of omeprazole, 20 mg daily for 4 weeks, in 11 patients with both asthma and GER in a randomized, double-blind, placebo-controlled, crossover protocol. There was a 1-week run-in period at the beginning of the study and a 1-week washout period between treatment periods. No improvement in GER or asthma symptoms, bronchodilator use, or PEFR was found in this relatively low-dose, short-term study of only 11 subjects. canadian neighbor pharmacy

Teichtahl et al studied the effects of omeprazole, 40 mg/d for 4 weeks, in 20 patients in a randomized, placebo-controlled, crossover trial. Although GER symptoms improved, eight patients who underwent ambulatory pH monitoring while taking omeprazole did not demonstrate a reduction in physiologic GER. A small but statistically significant improvement in evening PEF, from 79±4% to 82±4% of the predicted value (mean±SEM), occurred. However, asthma symptoms, P-agonist requirements, morning PEFR, diurnal PEF variability, and spirometry did not improve. As in GoodalPs study, the change in evening PEF was significant by paired t test at the p<0.05 level. However, no correction for multiple comparisons was used even though several parameters were tested, increasing the likelihood that this small difference was due to chance.
In a double-blind, placebo-controlled, crossover study, Meier et al treated 15 asthmatics with GER (documented either by endoscopy or by 24-h pH monitoring) with omeprazole, 20 mg twice daily for 6 weeks, with a 2-week washout period between treatment arms. Four subjects experienced a 20% or greater improvement in FEVv The others did not respond favorably. All responders experienced complete esophageal healing, whereas five of the 11 nonresponders did not, suggesting that inadequate treatment of esophagitis may explain why some asthmatics with GER do not improve with antireflux therapy.
Harding et al studied the effects of a minimum of 3 months of therapy with omeprazole in 30 asthmatics with GER. The unique feature of this study was that the dose of omeprazole was adjusted with monthly esophageal pH monitoring to ensure that gastric acid production was adequately suppressed. Unfortunately, the study was neither blinded nor placebo-controlled. The group experienced improvement in both GER and asthma symptom scores, but not in PEF or spirometric values.


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