The predominance of heartburn among asthma sufferers led many specialists to suspect that acid reflux could be a trigger for the coughing, wheezing and breathlessness of asthma.
In fact, it has become standard practice to prescribe heartburn medication to people with poorly controlled asthma, even if they don’t have overt acid reflux symptoms.
But a new study of adults with inadequate asthma control without significant heartburn shows that heartburn medication does not help control their asthma symptoms.
The study, conducted by the American Lung Association’s Asthma Clinical Research Centers at 20 U.S. sites, is the most comprehensive to date. It demonstrated that participants who took esomeprazole (Nexium) had as many asthma episodes as participants who were given an inactive pill, or placebo. The findings will appear April 9, 2009, in the New England Journal of Medicine.
“This study goes against the idea that mild or silent acid reflux contributes to uncontrolled asthma,” says Mario Castro, M.D., a Washington University pulmonary specialist at Barnes-Jewish Hospital who led the study in St. Louis. “It establishes that heartburn medications are not indicated for adults with uncontrolled asthma when they have mild or no symptoms of acid reflux.”
However, Castro says prescription heartburn medication is still indicated for those with severe heartburn and poorly controlled asthma because it might improve asthma control in some of these patients.
The multicenter network is currently conducting a parallel study in children ages 6 to 17 who have poorly controlled asthma and no heartburn. Called SARCA (Studying Acid Reflux in Children with Asthma), the investigation will try to determine whether heartburn medication can help control asthma in younger patients.
“Acid reflux is fairly common in children,” Castro says. “And we know that a finding in adults doesn’t necessarily apply to children, so we feel it’s important to evaluate whether acid suppression in children with uncontrolled asthma is effective.”
Funding from the National Heart, Lung, and Blood Institute and the American Lung Association supported this research. The study drug and placebo were supplied by AstraZeneca. Castro reports receiving lecture fees from AstraZeneca.
Source: Washington University School of Medicine, USA