A proton-pump inhibitor, rabeprazole, improves ventilatory function in patients with asthma associated with gastroesophageal reflux.
BACKGROUND
Treatment of gastroesophageal reflux (GER) with proton-pump inhibitors (PPI) improves symptoms of asthma in some patients. However, the effects of a PPI on ventilatory function are still controversial. In this study, we measured ventilatory function in asthma patients treated with a PPI in order to identify those in whom a therapeutic effect on asthma can be expected from the acid suppression.


METHODS
From a cohort of 114 consecutive patients with bronchial asthma, 53 patients agreed to participate in the study and were treated with rabeprazole 20mg daily for 8 weeks during an asymptomatic, stable period with no exacerbations of their asthma. Of the 53 patients, 22 were diagnosed as GER on the basis of the QUEST questionnaire and endoscopic examination. The patients were monitored for improvement in ventilatory function.


RESULTS
Four patients dropped out because of adverse drug reactions. All the patients with GER noted an improvement in reflux symptoms with PPI treatment. An improvement of more than 20% in peak expiratory flow (PEF) was observed in 8 of 21 GER patients but in none of the non-GER patients. Factors predictive of improvement in PEF with rabeprazole therapy were the QUEST score (odds ratio: 1.47, 95% CI: 1.06-2.04, P = 0.022) and steroid-dependency of asthma (odds ratio: 0.01, 95% CI: 0.001-0.31, P = 0.008).


CONCLUSIONS
Treatment with rabeprazole is expected to ameliorate asthma in non-steroid-dependent patients who have symptomatic GER defined by the QUEST score.
Tsugeno
H
H
Dept. of Medicine, Misasa Medical Center, Okayama University Medical School, Misasa, Tottori, Japan. attractively21@yahoo.co.jp
Mizuno
M
M
Fujiki
S
S
Okada
H
H
Okamoto
M
M
Hosaki
Y
Y
Ashida
S
S
Mitsunobu
F
F
Tanizaki
Y
Y
Shiratori
Y
Y
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000031:analogs & derivatives; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors*; D012123:Pulmonary Ventilation / Q000187:drug effects* / Q000502:physiology; D064750:Rabeprazole; D012129:Respiratory Function Tests
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D064750:Rabeprazole; D006180:Proton-Translocating ATPases; D009853:Omeprazole