Asthma patients using powerful acid reflux drugs even though they don't have heartburn should stop taking them, lung experts say. It turns out the medicine doesn't improve asthma symptoms, as had been thought. Estimates are that 2.5 million to 5 million Americans with asthma also have gastroesophageal reflux, in which acid or food rises from the stomach into the throat, without any obvious heartburn symptoms.
Doctors believed that because of the apparent link between the two conditions, prescription medicines to treat acid reflux would reduce asthma flare-ups, breathing trouble and emergency room visits. Medical guidelines call for doctors to treat asthma patients for reflux disease if they have symptoms of it and to consider testing and treating if they don't.
Among the most popular treatments for severe heartburn are expensive prescription drugs called proton pump inhibitors, including Nexium and Protonix, which are meant to reduce stomach acid and ulcers. Another drug, Prilosec, now is available in a nonprescription version and also as a generic prescription drug, omeprazole.
A study published in Thursday's New England Journal of Medicine found that among 412 patients with poorly controlled asthma, the group given Nexium twice a day for six months fared no better in symptom control than patients getting dummy pills.Study leader Dr. Robert Wise, a lung specialist at Johns Hopkins University, said it gives the first solid evidence that "silent" acid reflux doesn't have a role in poor asthma control.
Doctors at some of the 19 medical centers participating in the study, concerned about patients taking unnecessary medicine, issued press releases with headlines such as, "Physician Alert," urging patients with "silent" reflux to stop taking the drugs.
Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, said asthma patients taking reflux medicine who don't have heartburn should talk to their doctors about whether to get off these drugs. The institute and the American Lung Association sponsored the study. AstraZeneca LLP, the maker of Nexium, provided the medicine used in the study.
In an editorial in the journal, Drs. Koichiro Asano and Hidekazu Suzuki of Keio University School of Medicine in Tokyo recommended that a study be done comparing surgical repair of gastroesophageal reflux with medication in asthma patients with reflux. They noted there's evidence the surgery improves asthma control. They said the failure of Nexium in this study does not mean there's no relationship between worsening asthma and gastroesophageal reflux.