Heartburn Meds Won't Help, May Harm Kids With
TUESDAY, Jan. 24 (HealthDay News) -- Children with asthma who
don't have heartburn and other signs of gastroesophageal reflux
don't get additional asthma control from acid-reducing medications,
according to new research.
And, taking these medications when there are no digestive issues
increases a child's risk of developing a respiratory infection,
reports the study.
"There's a strong epidemiological link between acid reflux and asthma," explained study co-author Janet Holbrook, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. As a result, current asthma guidelines call for evaluating people with asthma for acid reflux, Holbrook said.
Because definitive tests for excess acid production can cause
children discomfort, some doctors may choose to do a trial of
acid-suppressing medications called proton pump inhibitors (PPIs).
Some common brand names in this class of medication are Prilosec,
Prevacid and Nexium.
"Our findings suggest that physicians should not take kids with poorly controlled asthma and test whether PPIs will help," said Holbrook.
Results of the study are published in the Jan. 25 issue of the
Journal of the American Medical Association. The study was funded by the U.S. National Institutes of Health and conducted by the American Lung Association Asthma Clinical Research Centers.
Asthma and gastroesophageal reflux (GER or GERD) are common
conditions in children. Youngsters with asthma often have symptoms
of gastroesophageal reflux. In adults, PPIs seem to help people
with asthma who also have symptoms of gastroesophageal reflux, but
not those who don't have symptoms, such as frequent heartburn.
The current study included 306 children recruited from 19
centers across the United States between 2007 and 2010. The average
age was 11 years. All had poor asthma control despite receiving
treatment with inhaled corticosteroids.
The children were randomly assigned to receive either
lansoprazole -- a PPI -- or a placebo daily for six months. The
dose of lansoprazole was based on the child's weight.
Asthma improvement was assessed through a change in the Asthma
Control Questionnaire, which has a scale of 0 to 6. A change of 0.5
is considered clinically significant. Lung function was also
After six months, there were no statistically significant
differences between the groups. The average change in the Asthma
Control Questionnaire score was only 0.2, and there were no
statistically significant changes in lung function, quality of life
or rate of asthma flare-ups.
In addition, among 115 children who also had a 24-hour
esophageal acid study, 43 percent were found to have elevated
levels of acid production. Yet even in this group, treatment with
lansoprazole didn't improve asthma symptoms over placebo.
Holbrook said although this study only looked at one PPI, she
believes the results would hold true for other medications in this
class of drugs.
Children taking lansoprazole had about a 30 percent higher risk
of respiratory infections and sore throats in this study. PPIs were
also associated with a difference in the risk of activity-related
bone fractures, although the difference was not statistically
significant, according to an accompanying editorial in the same
issue of the journal.
"PPIs do not improve asthma in children who do not have symptoms of GER/GERD, and it is unlikely to be of great benefit even in children who do have such symptoms," said the editorial author, Dr. Fernando Martinez, director of the Arizona Respiratory Center at the University of Arizona in Tucson.
"The substantial increase in use of PPIs in children during the last decade is worrisome and unwarranted," he wrote.
Still, Martinez advised parents not to abruptly discontinue any
medications. Parents "should consult their pediatricians, who can
best evaluate the clinical situation for each child," he said.
Holbrook agreed and said if a child is on a PPI, it's reasonable
for parents to ask why. She noted that these medications may come
with an additional risk and cost, and they may not have any
"If your child is on a PPI for asthma, it's not an effective treatment. These medications are approved for the treatment of acid reflux," said Holbrook.
Learn more about asthma treatment from the
U.S. National Heart, Lung, and Blood
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