A new study overturns the long-held practice of treating chronic asthma patients with medication for acid reflux. The study published this week's New England Journal of Medicine finds that the drugs, such as Prilosec and Nexium, may not do anything to alleviate symptoms of asthma.
Some 32% to 84% of asthma patients the National Heart, Lung and Blood Institute estimates there are more than 22 million in the U.S. may suffer from acid reflux, or gastroesophageal reflux disease (GERD), according to past research cited in the current study. Only about half of those patients have the usual symptoms of GERD, such as nausea, chest pain or heartburn, but doctors think the condition may exacerbate asthma, possibly by causing aspiration of acid into the lungs. The common practice, set forth by National Institutes of Health guidelines, is to treat asthmatic patients particularly those who have severe and chronic disease with acid reflux drugs, when other traditional asthma treatments don't work.
"It's been a clinical impression for a long time that in some patients with asthma, if you treated their reflux, their asthma got better," says Dr. John Mastronarde, an author of the new study and the director of the asthma center at Ohio State University, who has prescribed the medications known as proton pump inhibitors (PPI) to about a quarter of his asthma patients.
But according to Mastronarde's study, which tracked 402 adults ages 18 or older with poorly controlled chronic asthma, the drugs had no impact on symptoms. Participants were randomly assigned to either a treatment or placebo group, and followed for six months using daily asthma diaries as well as spirometry tests and questionnaires at four-week intervals. Even among the roughly 40% of patients with confirmed GERD, the medication offered no benefit over the placebo.
"I was surprised," says Mastronarde. "I actually expected people would get better if they had acid in their esophagus."
"I would argue that we should change clinical practice on this particular point," he adds, pointing out that many past studies that have associated PPIs with improved asthma symptoms were hindered by small sample size, lack of clear GERD diagnoses or loose definitions of asthma itself. "I certainly will change my practice based on the outcome of this study."
Mastronarde cautions that asthma patients who have confirmed cases of GERD with noticeable symptoms, should continue to take their prescribed medication. But for many asthma patients who are given the drugs primarily as a treatment of asthma even without a diagnosis of GERD the medication may not be doing any good. "It is not going to help their asthma," Mastronarde says. What's more, the drugs may lead to unnecessary side effects and unwarranted cost.
"If a patient has asthma and is on a PPI, they need to talk to their physician and ask, 'Why am I on this?'" says Mastronarde, who is planning a similar study in children and teens with asthma.