Children’s Asthma Not Improved by Treating Symptomless Acid Reflux

(January 25, 2012)

A new study by the American Lung Association Asthma Clinical Research Centers Network (ALA-ACRC), recently published in the Journal of the American Medical Association, may have a significant impact on children with asthma who have also been prescribed acid-controlling medication.

Gastroesophageal reflux (GER) is a condition caused by acid coming up from the stomach into the esophagus. Asthma and GER are common disorders in children and symptoms of GER such as “heartburn,” vomiting, and difficulty swallowing are frequently reported among children with asthma.

There is debate in the medical community over whether or not undetected GER could contribute to poor asthma control in children taking inhaled steroids. Often, children with poorly controlled asthma symptoms are also prescribed acid controllers, even when they have no GER symptoms.

According to this new research—which was co-funded by the American Lung Association and the National Heart, Lung and Blood Institute (NHLBI), a component of the National Institutes of Health—adding prescription acid controllers to standard inhaled steroid treatment does not improve asthma symptoms or control in children.

These findings are significant because each year, more than 2.5 million children without GER symptoms, who have problems controlling their asthma, have been prescribed acid-controlling drugs called proton pump inhibitors (PPIs). The ALA-ACRC study set out to determine if this type of treatment was effective, or if these children were being prescribed an unnecessary and costly medication.

The trial, involving 360 children aged 6-17 years with poorly controlled asthma and without symptoms of GER, showed that children who received the PPI drug lansoprazole1 did not show signs of improved lung function or a decrease in asthma symptoms, compared to those who received a placebo. However, children who took lansoprazole had an increased risk of adverse effects, notably sore throats and bronchitis.

“We learned that children with poorly controlled often have acid-reflux, but treatment with a widely used medicine to decrease stomach acid not only did not improve asthma control, it led to some unwanted side effects including an increased number of upper respiratory infections. We hope that clinicians apply the results of this study and stop using medicines to decrease stomach acid in the unproven belief that this class of medications improves asthma control” says Gerald Teague, Lead PI at University of Virginia.

These results are similar to those found in a previous ALA-ACRC study, which examined the relationship between asthma and GER among adults. That study was published in the New England Journal of Medicine in 2009.

The American Lung Association advises that you always talk with your doctor before discontinuing any medication, because each patient’s specific needs are different.

The ACRC Network is an American Lung Association sponsored research program that conducts large scale clinical trials with the mission of advancing the care and treatment of people with asthma. The network, with a central data coordinating center and 18 clinical centers located across the country, is the largest nonprofit network of its kind. By placing numerous clinical centers nationwide, the ACRC Network is able to enroll large numbers of patients for clinical trials, thus ensuring relevant research findings can be interpreted with the highest level of scientific authority.

Citation

Lansoprazole is sold under the brand name Prevacid.