February 1, 2012
Prescriptions for proton pump inhibitors (PPIs) for children have jumped in recent years. Along with the trend, many children with asthma have been prescribed PPIs in the hopes of reducing asthma symptoms; undiagnosed acid reflux was believed to be a silent contributor to poorly controlled asthma. But a new JAMA study calls the practice into question after acid-suppressing therapy failed to provide significant improvement in asthma symptoms or lung function in kids. And the study raises concerns about the safety of using the medication long-term in children.
In the study, 300 children aged 6 to 17 with recent asthma exacerbations and no obvious acid reflux symptoms were treated with lansoprazole, a PPI medication, or a placebo—in addition to taking inhaled corticosteroids. After 6 months, the treatment group showed no significant improvement over the control group in measures such as breathing, cough and experiencing symptoms at night. Lansoprazole likewise showed no benefit in a subgroup of children with more telltale signs of acid reflux.
Potential Side Effects Cause Concern
In addition, the researchers noted more reports of upper respiratory tract infections, sore throats and bronchitis among children taking lansoprazole.
An uptick in bone fractures was also highlighted in an accompanying editorial. While the fractures could not be attributed directly to lansoprazole, Fernando D. Martinez, M.D. wrote: “...this finding should be considered in the framework of a substantial body of evidence that has prompted the U.S. Food and Drug Administration to issue an advisory about risk of fractures in adults taking PPIs chronically.”
The bottom line: While more research is needed, parents of children with asthma may want to proceed cautiously. Before starting or continuing treatment with a proton pump inhibitor, talk to your child's pediatrician or allergist about the pros and cons.
Sources:
"Lansoprazole for Children With Poorly Controlled Asthma: A Randomized Controlled Trial." The Writing Committee for the American Lung Association Asthma Clinical Research Centers. JAMA 2012; 307: 373-381.
Editorial: “Children, Asthma, and Proton Pump Inhibitors: Costs and Perils of Therapeutic Creep.” Fernando D. Martinez, M.D. JAMA 2012; 307: 406-407.
