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Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease
  1. K Størdal1,
  2. G B Johannesdottir2,
  3. B S Bentsen2,
  4. P K Knudsen2,
  5. K C L Carlsen2,
  6. O Closs3,
  7. M Handeland4,
  8. H K Holm5,
  9. L Sandvik6
  1. 1Dept of Paediatrics, Østfold County Hospital, 1602 Fredrikstad, Norway
  2. 2Dept of Paediatrics, Ullevaal University Hospital, 0407 Oslo, Norway
  3. 3Dept of Paediatrics, Ahus University Hospital, 1474 Nordbyhagen, Norway
  4. 4Dept of Paediatrics, Vestfold Hospital, 3103 Tønsberg, Norway
  5. 5Dept of Paediatrics, Oppland County Hospital, 2629 Lillehammer, Norway
  6. 6Center for Clinical Research, Ullevaal University Hospital, 0407 Oslo, Norway
  1. Correspondence to:
    Dr K Størdal
    Dept of Paediatrics, Østfold Central Hospital, 1602 Frederikstad, Norway; ketil.stoerdalc2i.net

Abstract

Background: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven.

Aim: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD.

Methods: Thirty eight children (mean age 10.8 years, range 7.2–16.8; 29 males) with asthma and a reflux index ⩾5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression.

Results: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI −0.1 to 2.65) and 1.28 (95% CI −0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment.

Conclusion: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.

  • asthma
  • gastroesophageal reflux disease
  • omeprazole
  • randomised controlled trial
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Footnotes

  • Competing interests: KS has been reimbursed from AstraZeneca for attending two conferences, and KS and BSB have received fees from AstraZeneca for speaking

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