The Efficacy of Proton Pump Inhibitors for the Treatment of Asthma in Adults
| Autor: | Eric Chiou, Walter W. Chan, Keith L. Obstein, Tom L. Whitlock, April S. Tignor |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Evening business.industry Peak Expiratory Flow Rate Proton Pump Inhibitors Subgroup analysis Publication bias Placebo medicine.disease Asthma Confidence interval respiratory tract diseases immune system diseases Internal medicine Meta-analysis Gastroesophageal Reflux Internal Medicine medicine Physical therapy Humans business Randomized Controlled Trials as Topic Morning |
| Zdroj: | Archives of Internal Medicine. 171 |
| ISSN: | 0003-9926 |
| DOI: | 10.1001/archinternmed.2011.116 |
| Popis: | Background Gastroesophageal reflux disease occurs frequently among patients with asthma. Therapy with proton pump inhibitors (PPIs) to improve asthma control remains controversial. We sought to evaluate the efficacy of PPIs in treatment of asthma using objective and subjective outcome measures. Methods A literature search was undertaken using MEDLINE (1950-January 2010), PubMed (1950-January 2010), EMBASE (1980-January 2010), and Cochrane Central Register of Controlled Trials (through January 31, 2010). Randomized, placebo-controlled trials evaluating the efficacy of PPIs for treatment of asthma in adults were selected. The primary outcome of interest was morning peak expiratory flow (PEF) rate. Secondary outcomes included objective (evening PEF rate and forced expiratory volume in 1 second) and subjective (asthma symptoms score and Asthma Quality of Life Questionnaire score) measures. Influence of study characteristics on outcomes was examined by subgroup analyses and meta-regression. Results Eleven trials (2524 patients) met inclusion criteria. Overall, patients had a higher mean morning PEF rate after treatment with PPIs compared with placebo (mean difference, 8.68 L/min [95% confidence interval, 2.35-15.02]). No significant single large-study effect, temporal effect, or publication bias was seen. Subgroup analysis revealed a trend toward a larger improvement in morning PEF rate in studies enrolling only patients with gastroesophageal reflux disease (mean difference, 16.90 L/min [95% confidence interval, 0.85-32.95]). Analyses of secondary outcomes (asthma symptoms score, Asthma Quality of Life Questionnaire score, evening PEF rate, and forced expiratory volume in 1 second) showed no significant difference between PPIs and placebo. Conclusions Proton pump inhibitor therapy in adults with asthma results in a small, statistically significant improvement in morning PEF rate. The magnitude of this improvement, however, is unlikely to be of meaningful clinical significance. There is insufficient evidence to recommend empirical use of PPIs for routine treatment of asthma. |
| Databáze: | OpenAIRE |
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