PPIs not effective for routine use in adults with asthma

January 01, 0001

PPIs not effective for routine use in adults with asthma

These US authors sought to evaluate the efficacy of proton pump inhibitors (PPIs) in treatment of asthma using objective and subjective outcome measures in a meta-analysis of randomized controlled trials. 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.

They found: "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). 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). 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."

The authors concluded: "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."

Save PPIs for selected cases.

For the full abstract, click here.

Arch Intern Med 171(7):620-629, 11 April 2011
© 2011 to the American Medical Association
The Efficacy of Proton Pump Inhibitors for the Treatment of Asthma in Adults-A Meta-analysis. Walter W. Chan, Eric Chiou, Keith L. Obstein, April S. Tignor, Tom L. Whitlock. Correspondence to Dr. Chan: wwchan@partners.org

Category: R. Respiratory. Keywords: proton pump inhibitors, PPIs, adults, asthma, meta-analysis of randomized controlled trials, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 April 2011

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