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 19 April 2018

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News

Esomeprazole does not improve poorly controlled asthma

This week's New England Journal of Medicine examines the efficacy of esomeprazole for treatment of poorly controlled asthma.

News image

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Gastroesophageal reflux is common among patients with asthma but often causes mild or no symptoms.

It is not known to the The Lung Association in Ohio, USA, whether treatment of gastroesophageal reflux with proton-pump inhibitors in patients who have poorly controlled asthma without symptoms of gastroesophageal reflux can substantially improve asthma control.

The Association evaluated in a parallel-group, double-blind trial, 412 participants with inadequately controlled asthma, despite treatment with inhaled corticosteroids.

The patients had minimal or no symptoms of gastroesophageal reflux to receive either 40 mg of esomeprazole twice a day or matching placebo.

Participants were followed for 24 weeks with the use of daily asthma diaries,
Participants were followed for 24 weeks.
New England Journal of Medicine.
spirometry performed once every 4 weeks, and questionnaires that asked about asthma symptoms.

The Association used ambulatory pH monitoring to ascertain the presence or absence of gastroesophageal reflux in the participants.

The primary outcome was the rate of episodes of poor asthma control, as assessed on the basis of entries in asthma diaries.

The Association found that episodes of poor asthma control occurred with similar frequency in the placebo and esomeprazole groups.

There was no treatment effect with respect to individual components of the episodes of poor asthma control or with respect to secondary outcomes.

The secondary outcomes, including pulmonary function, airway reactivity, asthma control, symptom scores, nocturnal awakening, or quality of life were not influenced by treatment.

The presence of gastroesophageal reflux, which was documented by pH monitoring in 40% of participants with minimal or no symptoms, did not identify a subgroup of patients that benefited from treatment with proton-pump inhibitors.

There were fewer serious adverse events among patients receiving esomeprazole than among those receiving placebo.

The Association concluded, “Despite a high prevalence of asymptomatic gastroesophageal reflux among patients with poorly controlled asthma, treatment with proton-pump inhibitors does not improve asthma control.”

“Asymptomatic gastroesophageal reflux is not a likely cause of poorly controlled asthma.”

NEJ M 2009: 360(4): 1487-99
16 April 2009

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