Level 2: Mid-level evidence
Gastroesophageal reflux (GER) is common in children with asthma, and the National Heart, Lung, and Blood Institute recommends treatment for GER symptoms, especially in children with frequent episodes of nocturnal asthma (Allergy Clin Immunol. 2007;120:S94-S138).
Proton pump inhibitors (PPIs) are sometimes prescribed for children to improve asthma control, even in the absence of GER symptoms. A new randomized trial investigated the effects of a PPI on asthma outcomes in 306 children with asthma poorly controlled by inhaled corticosteroids (JAMA. 2012;307:373-381).
Children (mean age 11 years) were randomized to lansoprazole (Prevacid) vs. placebo for 24 weeks. All children were free of GER symptoms. Exclusion criteria included any reflux symptoms requiring treatment, any previous use of PPIs or other anti-reflux medications, or history of anti-reflux surgery. The lansoprazole dose was 15 mg/day for children weighing <30 kg (66 lbs) and 30 mg/day for children weighing >30 kg.
The primary outcome was change in score on the Asthma Control Questionnaire (ACQ), which assesses wheezing, shortness of breath, nocturnal symptoms, activity level, bronchodilator use, and pulmonary function. A change of 0.5 points is considered clinically important (reduction indicates improvement).
At 24 weeks, there were no significant differences in ACQ scores (mean reduction 0.1 points for lansoprazole vs. 0.2 points for placebo). Lansoprazole was associated with higher rates of upper respiratory infection (63% vs. 49%, P=0.02, NNH 7), sore throat (52% vs. 39%, P=0.02, NNH 7), and bronchitis (7% vs.2% P=0.04, NNH 20). There were no significant differences in asthma-related quality-of-life outcomes or in rate of episodes of poor asthma control.
Alan Ehrlich, MD, is a deputy editor for DynaMed, in Ipswich, Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School in Worcester.
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