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Lansoprazole reduce frequency of COPD exacerbations in older patients
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respiratory medicine: copd update 5 (2009) 81e89
Lansoprazole reduce frequency of COPD exacerbations in older patients
Gastro-oesophageal reflux can cause chronic cough which might result in deterioration of COPD symptoms typical of exacerbation. Reflux might also be associated with exacerbation through micro-aspiration. Therapy with proton pump inhibitors (PPI) could conceivably reduce exacerbations and PPIs also have immunomodulatory effects. This study examines whether PPI therapy is associated with a reduced incidence of COPD exacerbation.
Abstract of Original Article Ojectives: To investigate whether proton pump inhibitor (PPI) therapy reduces the frequency of common colds and exacerbations in patients with chronic obstructive pulmonary disease (COPD). Design: Twelve-month, randomized, observer-blind, controlled trial. Setting: A university hospital and three city hospitals in Miyagi prefecture in Japan. Participants: One hundred patients with COPD (mean age SD 74.9 8.2) participated. They were all ex-smokers and had received conventional therapies for COPD, including smoking cessation and bronchodilators. Patients with gastroesophageal reflux disease or gastroduodenal ulcer were excluded. Intervention: Patients were randomly assigned to conventional therapies (control group) or conventional therapies plus PPI (lansoprazole 15 mg/d; PPI group) and observed for 12 months.
Measurements: Frequency of common colds and COPD exacerbations. Results: The number of exacerbations per person in a year in the PPI group was significantly lower than that in the control group (0.34 0.72 vs 1.18 1.40; P<.001). The adjusted odds ratio with logistic regression for having exacerbation (once/year) in the PPI group compared with the control group was 0.23 (PZ.004). In contrast, there was no significant difference in the numbers of common colds per person per year between the PPI group and the control group (1.22 2.09 vs 2.04 3.07; PZ.12). PPI therapy significantly reduced the risk of catching frequent common colds (3 times/year), the adjusted odds ratio of which was 0.28 (PZ.048). Conclusion: In this single-blind, nonplacebo-controlled trial, lansoprazole was associated with a significant decrease in COPD exacerbations. More definitive clinical trials are warranted. Abstract used with permission from Wiley-Blackwell
Commentary by Olga Mikulich Mater Misericordiae Hospital, Dublin, Ireland Common colds relate to exacerbations of COPD. Proton-Pump Inhibitors (PPI) drugs also inhibit production of proinflammatory cytokines. This study investigated if PPI therapy prevents common colds and subsequent exacerbation in patients with COPD. This study was performed in 103 patients (51 in the PPI group and 52 controls), matched for their FEV1, smoking history and treatment, and who were followed up for 12 months on a fortnightly basis. All the patients were Japanese with a mean age of 74. About 40% in each group had advanced disease (COPD stage III and IV). Patients with gastro-oesophageal symptoms were excluded from the study. COPD exacerbation was defined by the necessity to alter treatment adding antimicrobial agents and systemic corticosteroids. Common colds were established using symptoms-based questionnaire scoring. 3 patients were lost to follow up. Lansoprazole at a dose of 15 mg/day significantly reduced the frequency of catching common colds and COPD exacerbations. The same number of patients in both groups had at least one cold a year (26 in PPI vs 27 in control), but the number of patients with frequent colds (>3 a year) was significantly lower in PPI group (6 vs 13 in control group). At least one COPD exacerbation was recorded in 1 in 2 patients in control group, compared to 1 in 4 in the PPI group. The total number of exacerbations was also fewer in patients taking Lansoprazole (0.34 vs 1.18/year). The efficiency of PPIs in decreasing number of COPD exacerbations and number of frequent common colds was confirmed by further multivariate analyses after all adjustments. More advanced COPD (stage IV) was independently and significantly associated with a higher incidence of common colds (Odds Ratio 43.2) and COPD exacerbations (Odds Ratio 45.6). Although this study showed that low-dose PPIs in COPD patients decreases the number of exacerbations, the effect was predominantly seen in patients with less advanced disease. More studies, including placebo-controlled and those with larger scale are needed to assess this interesting therapeutic avenue.
Original article reference: Sasaki, Takahiko; Nakayama, Katsutoshi; Yasuda, Hiroyasu; Yoshida, Motoki1; Asamura, Takaaki1; Ohrui, Takashi1; Arai, Hiroyuki1; Araya, Jun2; Kuwano, Kazuyoshi2; Yamaya, Mutsuo: A Randomized, Single-Blind Study of Lansoprazole for the Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease in Older Journal of the American Geriatrics Society, Volume 57, Number 8, August 2009, pp. 1453-1457(5).
doi:10.1016/j.rmedu.2009.10.006
respiratory medicine: copd update 5 (2009) 81e89
Lansoprazole reduce frequency of COPD exacerbations in older patients
Gastro-oesophageal reflux can cause chronic cough which might result in deterioration of COPD symptoms typical of exacerbation. Reflux might also be associated with exacerbation through micro-aspiration. Therapy with proton pump inhibitors (PPI) could conceivably reduce exacerbations and PPIs also have immunomodulatory effects. This study examines whether PPI therapy is associated with a reduced incidence of COPD exacerbation.
Abstract of Original Article Ojectives: To investigate whether proton pump inhibitor (PPI) therapy reduces the frequency of common colds and exacerbations in patients with chronic obstructive pulmonary disease (COPD). Design: Twelve-month, randomized, observer-blind, controlled trial. Setting: A university hospital and three city hospitals in Miyagi prefecture in Japan. Participants: One hundred patients with COPD (mean age SD 74.9 8.2) participated. They were all ex-smokers and had received conventional therapies for COPD, including smoking cessation and bronchodilators. Patients with gastroesophageal reflux disease or gastroduodenal ulcer were excluded. Intervention: Patients were randomly assigned to conventional therapies (control group) or conventional therapies plus PPI (lansoprazole 15 mg/d; PPI group) and observed for 12 months.
Measurements: Frequency of common colds and COPD exacerbations. Results: The number of exacerbations per person in a year in the PPI group was significantly lower than that in the control group (0.34 0.72 vs 1.18 1.40; P<.001). The adjusted odds ratio with logistic regression for having exacerbation (once/year) in the PPI group compared with the control group was 0.23 (PZ.004). In contrast, there was no significant difference in the numbers of common colds per person per year between the PPI group and the control group (1.22 2.09 vs 2.04 3.07; PZ.12). PPI therapy significantly reduced the risk of catching frequent common colds (3 times/year), the adjusted odds ratio of which was 0.28 (PZ.048). Conclusion: In this single-blind, nonplacebo-controlled trial, lansoprazole was associated with a significant decrease in COPD exacerbations. More definitive clinical trials are warranted. Abstract used with permission from Wiley-Blackwell
Commentary by Olga Mikulich Mater Misericordiae Hospital, Dublin, Ireland Common colds relate to exacerbations of COPD. Proton-Pump Inhibitors (PPI) drugs also inhibit production of proinflammatory cytokines. This study investigated if PPI therapy prevents common colds and subsequent exacerbation in patients with COPD. This study was performed in 103 patients (51 in the PPI group and 52 controls), matched for their FEV1, smoking history and treatment, and who were followed up for 12 months on a fortnightly basis. All the patients were Japanese with a mean age of 74. About 40% in each group had advanced disease (COPD stage III and IV). Patients with gastro-oesophageal symptoms were excluded from the study. COPD exacerbation was defined by the necessity to alter treatment adding antimicrobial agents and systemic corticosteroids. Common colds were established using symptoms-based questionnaire scoring. 3 patients were lost to follow up. Lansoprazole at a dose of 15 mg/day significantly reduced the frequency of catching common colds and COPD exacerbations. The same number of patients in both groups had at least one cold a year (26 in PPI vs 27 in control), but the number of patients with frequent colds (>3 a year) was significantly lower in PPI group (6 vs 13 in control group). At least one COPD exacerbation was recorded in 1 in 2 patients in control group, compared to 1 in 4 in the PPI group. The total number of exacerbations was also fewer in patients taking Lansoprazole (0.34 vs 1.18/year). The efficiency of PPIs in decreasing number of COPD exacerbations and number of frequent common colds was confirmed by further multivariate analyses after all adjustments. More advanced COPD (stage IV) was independently and significantly associated with a higher incidence of common colds (Odds Ratio 43.2) and COPD exacerbations (Odds Ratio 45.6). Although this study showed that low-dose PPIs in COPD patients decreases the number of exacerbations, the effect was predominantly seen in patients with less advanced disease. More studies, including placebo-controlled and those with larger scale are needed to assess this interesting therapeutic avenue.
Original article reference: Sasaki, Takahiko; Nakayama, Katsutoshi; Yasuda, Hiroyasu; Yoshida, Motoki1; Asamura, Takaaki1; Ohrui, Takashi1; Arai, Hiroyuki1; Araya, Jun2; Kuwano, Kazuyoshi2; Yamaya, Mutsuo: A Randomized, Single-Blind Study of Lansoprazole for the Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease in Older Journal of the American Geriatrics Society, Volume 57, Number 8, August 2009, pp. 1453-1457(5).
doi:10.1016/j.rmedu.2009.10.006