title: Changes in pulmonary hyperinflation and bronchial hyperresponsiveness following treatment with lansoprazole in children with cystic fibrosis.
abstract: SUMMARY. In this prospective open study of 14 children with cystic fibrosis (CF), we evaluated the effect of 1 year adjuvant therapy with lansoprazole, a proton pump inhibitor (PPI), on growth, fecal fat loss, body composition and lung function. Only stable patients with pancreatic insufficiency were included, and their data were compared to those of a large Dutch pediatric normal reference population. During the use of the PPI, mean weight and height did not change significantly, while body mass index improved (P < 0.05). An immediate significant and persistent reduction of fecal acid steatocrit (P < 0.05) was demonstrated. Compared to normal Dutch children, the CF patients showed significantly decreased standard deviation scores (SDS) for total body fat (TBF, -0.966) and fat-free mass (FFM, -1.826). Under lansoprazole, TBF improved significantly (P < 0.05), while mean FFM remained unchanged. A significant improvement in total lung capacity (P < 0.05), residual volume (P = 0.055), and maximal inspiratory mouth pressure (P = 0.002) was also demonstrated. Hyperinflation tended to decrease during the use of a PPI. Daily recordings of peak expiratory flow (PEF) showed a maximal diurnal variability of 28% of recent best PEF and minimal morning PEF of 72% of recent best PEF, confirming that bronchial hyperresponsiveness is increased in CF. We conclude that adjuvant therapy with lansoprazole in young CF patients with persistent fat malabsorption, decreased fat losses and improved total body fat. Lung hyperinflation decreased, which may partly explain the improvement in inspiratory muscle performance. The simultaneous improvements in body composition and lung hyperinflation suggest a relationship between these two parameters. Further research is necessary to confirm such a relationship and to elucidate the mechanisms involved.
authors.affiliation: Department of Paediatrics, University Hospital and University of Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. jhe@skin.azm.nl
authors.forename: J J
authors.initials: JJ
authors.lastname: Hendriks
authors.forename: A D
authors.initials: AD
authors.lastname: Kester
authors.forename: R
authors.initials: R
authors.lastname: Donckerwolcke
authors.forename: P P
authors.initials: PP
authors.lastname: Forget
authors.forename: E F
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000273:Adipose Tissue / Q000187:drug effects; D000293:Adolescent; D001823:Body Composition / Q000187:drug effects; D001827:Body Height / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D016535:Bronchial Hyperreactivity / Q000503:physiopathology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000503:physiopathology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy / Q000503:physiopathology; D005243:Feces / Q000737:chemistry; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D064747:Lansoprazole; D050356:Lipid Metabolism; D008168:Lung / Q000187:drug effects*; D008297:Male; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012115:Residual Volume / Q000187:drug effects; D018709:Statistics, Nonparametric; D014109:Total Lung Capacity / Q000187:drug effects
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole