Treatment for Acid Reflux Does Not Improve Asthma

New research suggests that a widely used treatment for persistent acid reflux among asthmatics doesn’t actually improve their quality of life. The finding that as many as one-third of those studied showed no improvement makes a strong case arguing that physicians should change how they currently treat these patients.

John Mastronarde, a clinical associate professor of medicine at Ohio State University, along with scientists nationally, sought to determine if acid reflux disease, commonly known as gastroesophageal reflux disease, or GERD, worsens asthma symptoms. Mastronarde is a pulmonologist and critical care specialist at Ohio State’s Medical Center and director of its asthma center.

Also, the researchers wanted to determine if the use of a class of drugs called proton pump inhibitors in poorly controlled asthmatic patients without GERD symptoms would significantly improve asthma control. Up to 20 percent of asthma patients with reflux do not have heartburn symptoms.

The results appear in tomorrow’s (4/9) issue of the New England Journal of Medicine.

“We found that ‘silent’ GERD is likely not the cause of poorly controlled asthma, and treatment with proton pump inhibitors does not improve control or provide any benefit to the patients,” says Mastronarde, who is also lead investigator of the multicenter study.

“This research is especially important because, by determining which patients do not need the additional medication, we are saving them unnecessary costs, potential side effects and the risk of interactions with other drugs,” adds Mastronarde.

Researchers from 20 universities examined 402 adults with asthma for 24 weeks to determine if using a proton pump inhibiting drug would alleviate their asthma symptoms by preventing the release of stomach and intestinal acid.

The study participants were randomized to receive either 40 milligrams of the drug esomeprazole or a placebo, and were monitored to see if asthma symptoms improved. Esomeprazole is a key ingredient in the popular drugs Prilosec and Nexium, among others. Researchers tracked patients’ lung function and measured esophageal acid, collected questionnaire responses related to asthma symptoms and control, and reviewed quality-of-life issues documented in diaries. Reports showed no benefits to participants receiving esomeprazole.

Approximately 20 million Americans have asthma, exhibiting symptoms such as coughing, wheezing, tightness in the chest and shortness of breath. Treatment options involve a combination of quick-relief medicines to expand constricted airways and long-term medications to reduce inflammation or relax muscles. Although asthma can be controlled, the disease is still responsible for between 4,000 and 5,000 deaths in the United States each year.

Symptoms of asthma and GERD often overlap, making it difficult for physicians to distinguish between the two conditions, and about half of asthma patients who have reflux also have no symptoms. Acid reflux causes the airways in the lungs to constrict and asthmatic narrowing of the airways can induce acid reflux.

Funding from the National Heart, Lung and Blood Institute and the American Lung Association supported the SARA (study of acid reflux and asthma) trial.

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Source: Ohio State University

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