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Esomeprazole Therapy for Asthma: Marginal Benefit
Asthma patients received little benefit from potent acid suppression.
An association between gastroesophageal reflux disease (GERD) and asthma is acknowledged widely, but the effect of GERD therapy on asthma control has been inconsistent in previous studies. Some research has suggested a particular association between GERD and nocturnal asthma symptoms.
This industry-sponsored trial included 3 subgroups of adults with stable asthma: One subgroup had nocturnal asthma symptoms and no GERD, one had GERD and no nocturnal asthma symptoms, and one had both GERD and nocturnal asthma symptoms. All 700 patients were randomized to receive either esomeprazole (Nexium; 40 mg) or placebo twice daily. Nearly all patients used inhaled corticosteroids.
The primary outcome was change in mean morning peak expiratory flow (PEF). Compared with placebo, esomeprazole did not significantly improve morning PEF at 16 weeks in any of the subgroups, although the difference between placebo and esomeprazole in the entire study population approached significance (P=0.06). Esomeprazole was associated with a small but statistically significant improvement in one secondary outcome — evening PEF — in the subgroup with both GERD and nocturnal symptoms (mean change, 309 L/min to 335 L/min with esomeprazole and 315 L/min to 329 L/min with placebo; P=0.02). However, other secondary outcomes (e.g., use of rescue inhalers, quality-of-life scores) did not improve with esomeprazole.
Comment: In this study, potent acid-suppressive therapy resulted in only marginal benefit among asthma patients — even those with both GERD and nocturnal asthma symptoms. The authors acknowledge a need for additional research to identify patients with asthma who clearly will benefit from acid suppression.
— Allan S. Brett, MD
Published in Journal Watch General Medicine June 6, 2006
Citation(s):
Kiljander TO et al. Effects of esomeprazole 40 mg twice daily on asthma: A randomized placebo-controlled trial. Am J Respir Crit Care Med 2006 May 15; 173:1091-7.
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