The controversial practice of using proton pump inhibitors (PPIs) to improve asthma control has been dealt another blow by the results of a recent literature review.

An analysis of 11 published trials involving 2,524 patients indicates that although PPI therapy can yield a small, statistically significant improvement in morning peak expiratory flow (PEF) rate in adults with asthma, the magnitude of this improvement is unlikely to be of meaningful clinical significance.

According to researchers, the association between asthma and gastroesophageal reflux disease (GERD) has been well established, and as many as 40% to 80% of asthma sufferers also have GERD. PPIs are the cornerstone of medical treatment for acid reflux, but their effectiveness against asthma symptoms in the absence of esophageal symptoms has been the subject of debate. A meta-analysis of published studies was conducted to evaluate the efficacy of PPI use on asthma control in adults with or without symptomatic GERD.

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For the primary outcome of interest — morning PEF rate — nine randomized controlled trials involving 2,167 patients revealed a small, statistically significant improvement in persons with asthma treated with PPIs vs. placebo, with an incremental benefit for patients also diagnosed with GERD.

However, analyses of secondary outcomes — asthma symptoms score, Asthma Quality of Life Questionnaire score, evening PEF rate, and forced expiratory volume in 1 second — showed no significant differences between PPIs and placebos.

“The use of PPIs in most patients with asthma is unlikely to result in significant clinical benefit,” the researchers concluded.

Chan WW et al. Arch Intern Med. 2011;171:620-629