PPI prescribed for asthma ineffective and too expensive

Apr 13 2009

According to researchers in the U.S. millions of asthma patients taking the drug Nexium, (esomeprazole), or a similar drug are doing so unnecessarily.

Nexium made by drug company AstraZeneca was developed to treat acid reflux and has been widely prescribed for decades to relieve the symptoms of asthma.

But now scientists say Nexium which is a proton pump inhibitor (PPI), is not effective against asthma and does not reduce breathlessness and other symptoms.

A PPI is usually prescribed on the basis that there may be a link between stomach acid that backs up into the esophagus and poorly controlled asthma and because many asthma patients also have reflux.

The drugs first became available in the 1990s and they aim to control respiratory flare-ups in asthmatics for whom steroid therapy and other drugs have already failed.

But researchers at the Ohio State Medical Center's asthma center collected detailed health reports on 412 men and women with asthma symptoms despite drug therapy - half took daily doses of the most commonly used proton pump inhibitor -- 80 milligrams of esomeprazole (Nexium) -- while the rest received a placebo.

The volunteers had no better control over their asthma whether they were given the placebo pills or Nexium and the researchers say the longstanding practice of prescribing PPIs is "ineffective" and "unnecessarily expensive.

Dr. John Mastronarde who led the study says evidence suggests that proton-pump inhibitors should not be routinely prescribed for asthma symptoms if the patient does not have symptoms of gastroesophageal reflux and he believes the study results will change clinical practice and suspects the finding applies to all Nexium-type PPIs.

Proton pump inhibitors cost between $150 and $180 each month for the most common brands and the findings could mean that millions of dollars spent each year treating reflux disease in asthma patients, could be saved.

Dr. Elizabeth Nabel, director of the National Heart Lung and Blood Institute, which helped fund the study, says asthma patients who take medication for acid reflux but who do not have reflux symptoms should talk with their doctors about whether they should continue taking the medication.

In their search to find a subgroup of people the drug might help, the stomach acid of the volunteers was tracked to see if those who had reflux (40% did) would benefit and it was in vain; the researchers say there is no reason to test for reflux in patients with asthma unless they have symptoms.

Researchers in the 20 centers in the U.S. involved in the study are now examining the same question in children and have already enrolled 186 of the 300 youngsters age 5 to 17 they hope will take part in a new study.

Protonix, Prevacid and Aciphex are other PPIs.

The study is published in the New England Journal of Medicine.