Posted Jan 26, 2012
Acid-reflux medications appear to do more harm than good when prescribed to certain children with asthma, according to a new study.
Researchers found that lansoprazole, which sells under several brand names, including Prevacid, increased the risk of respiratory infections and did not improve asthma control in children who didn’t have reflux symptoms.
Doctors have long believed in a connection between reflux and asthma flare-ups, said Dr. Karen McCoy, who worked on the study and is chief of pulmonary medicine at Nationwide Children’s Hospital.
And they sometimes prescribe reflux medicine even when the child has no symptoms, in hopes it will improve asthma control.
Researchers monitored 306 children who were given the medication or a sugar pill for six months. The researchers found that the drug did not improve asthma control and significantly increased respiratory-tract infections, sore throats and bronchitis.
“This should change practice,” said Dr. John Mastronarde, director of Ohio State University’s asthma center and one of the authors of the study, which was published in The Journal of the American Medical Association and supported by the American Lung Association and the National Institutes of Health.
Lansoprazole is one of several proton-pump inhibitors that also include Prilosec and Nexium. In 2002, about 875,000 children were prescribed the medications. That number increased to 2.6 million (5 percent of all children in the U.S.) by 2009.
It’s unclear how many of those prescriptions were for children who have asthma and no reflux symptoms.
This study wasn’t designed to determine whether the medications improve asthma control in patients with symptoms of reflux, and data on that is limited, Mastronarde said.
McCoy said she could understand if — in rare cases — a doctor recommended a short trial of a proton-pump inhibitor on the belief that asymptomatic reflux was contributing to asthma flare-ups. But for the most part, “this is a game-changer,” she said.
Parents should contact their child’s doctor before making any change in treatment, McCoy said.
Dr. Sridhar Guduri, a specialist with Allergy & Asthma Clinics of Ohio, said he has never prescribed reflux medications in asymptomatic asthma patients because there wasn’t good evidence that it helped.
Dr. Fernando Martinez of the Arizona Respiratory Center wrote an editorial accompanying the research. He said he is concerned because there were six bone fractures in those children who received the medication compared with one fracture in the placebo group.
He pointed out that the U.S. Food and Drug Administration has issued an advisory about fracture risks in adults who take proton-pump inhibitors.
The researchers on the study did not consider the fractures data statistically significant, and they pointed out that some of the fractures happened early in the research, not after the children had been on the medication for a long time.
mcrane@dispatch.com
©2012 The Columbus Dispatch (Columbus, Ohio)
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