Article (Scientific journals)
Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD.
Baumeler, Luzia; Papakonstantinou, Eleni; Milenkovic, Branislava et al.
2016In Respirology, 21 (5), p. 883-90
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Keywords :
anti-gastroesophageal reflux disease therapy; chronic obstructive pulmonary disease; chronic obstructive pulmonary disease exacerbations; gastroesophageal reflux disease; proton pump inhibitors
Abstract :
[en] BACKGROUND AND OBJECTIVE: Gastroesophageal reflux disease (GERD) symptoms are associated with a higher risk of chronic obstructive pulmonary disease (COPD) exacerbation. We hypothesize that treatment with proton pump inhibitors reduces the risk of exacerbation in patients with stable COPD. METHODS: A total of 638 patients with stable COPD for >/=6 weeks, >/=10 pack-years of smoking and Global Initiative for Chronic Obstructive Lung Disease II-IV seeking care in tertiary hospitals in eight European countries in the Predicting Outcome using Systemic Markers in Severe Exacerbations-COPD cohort was prospectively evaluated by us. Comorbidities including associated medical treatment were assessed at baseline, at exacerbation and at biannual visits. Median observation time was 24 months. The primary study outcomes were exacerbation and/or death. RESULTS: A total of 85 (13.3%) of COPD patients were on anti-GERD therapy. These patients had higher annual and higher severe exacerbation rates (P = 0.009 and P = 0.002), decreased quality of life (SF-36: activity score P = 0.004, St. George's Respiratory Questionnaire: physical functioning P = 0.013 and social functioning P = 0.007), higher body mass airflow obstruction, dyspnea and exercise capacity index (P = 0.033) and Modified Medical Research Council scores (P = 0.002), shorter 6-min walking distance (P = 0.0004) and a higher adjusted Charlson score (P < 0.0001). Anti-GERD therapy was associated with a shorter time to severe exacerbation (HR 2.05 95% CI 1.37-3.08). Using three multivariable Cox-regression models, this association was independent of the following: (i) adjusted Charlson score and FEV1% predicted (HR 1.91 95% CI 1.26-2.90); (ii) adjusted Charlson score, body mass, airflow obstruction, dyspnea and exercise capacity index and Modified Medical Research Council (HR 1.62 95% CI 1.04-2.54); and (iii) adjusted Charlson score, FEV1% predicted and nine classes of medication for comorbidities (HR 1.63 95% CI 1.04-2.53). CONCLUSION: These findings suggest that patients with stable COPD receiving acid-suppressive therapy with proton pump inhibitors remain at high risk of frequent and severe exacerbations.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Baumeler, Luzia
Papakonstantinou, Eleni
Milenkovic, Branislava
Lacoma, Alicia
Louis, Renaud ;  Université de Liège > Département des sciences cliniques > Pneumologie - Allergologie
Aerts, Joachim G.
Welte, Tobias
Kostikas, Konstantinos
Blasi, Francesco
Boersma, Wim
Torres, Antoni
Rohde, Gernot G. U.
Boeck, Lucas
Rakic, Janko
Scherr, Andreas
Tamm, Michael
Stolz, Daiana
More authors (7 more) Less
Language :
English
Title :
Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD.
Publication date :
July 2016
Journal title :
Respirology
ISSN :
1323-7799
eISSN :
1440-1843
Publisher :
Blackwell, Oxford, United Kingdom
Volume :
21
Issue :
5
Pages :
883-90
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) 2016 Asian Pacific Society of Respirology.
Available on ORBi :
since 06 February 2017

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