Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study.

Abstract

Forty eight patients with moderate to severe asthma were enrolled in a double blind crossover study designed to evaluate the effects of ranitidine treatment, 150 mg twice daily for four weeks, on gastro-oesophageal reflux, asthma control, and bronchial reactivity. All 48 had a history of reflux symptoms and 27 had in addition reflux associated respiratory symptoms. Thirty two patients had objective evidence ofacid reflux on 24 hour pH monitoring (pH ofless than 4 for more than I % of the 24 hours) and 27 patients had a positive result in the acid perfusion test. Reflux symptoms were significantly improved after ranitidine treatment. Ranitidine treatment was associated with modest improvements in nocturnal asthma and daily use of inhaled bronchodilator drugs but there was no significant change in bronchial reactivity, lung function, peak flow, or the number of eosinophils in the blood. Comparisons between the effect of ranitidine treatment on asthma control were performed between patients with and without a history of reflux associated respiratory symptoms, with and without a positive result in the acid perfusion test, and with and without objective evidence of gastrooesophageal reflux. A history of reflux associated respiratory symptoms was the only factor that predicted an improvement in asthma control after ranitidine treatment. These results indicate that antireflux treatment will produce only small improvements in asthma control in asthmatic patients with a history of gastro-oesophageal reflux.

The relationship between gastroesophageal reflux and asthma: an update

“…Relationship between treatment of GERD and asthma outcomes Initial studies focused on the effects of treatment of GERD on asthma outcomes revealed inconsistent results, but in general seemed to suggest an overall improvement in some asthma symptoms [Kiljander et al 1999;Boeree et al 1998;Levin et al 1998;Teichtahl et al 1996;Ford et al 1994;Meier et al 1994;Gustafsson et al 1992;Larrain et al 1991;Ekstrom et al 1989;Nagel et al 1988;Goodall et al 1981;Kjellen et al 1981]. These data resulted in recommendations by the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3) that 'gastroesophageal reflux treatment may benefit patients who have asthma and complain of frequent heartburn or pyrosis, particularly those who have frequent nighttime asthma symptoms.…”

“…The analysis included 12 randomized controlled trials with a combined total of 432 subjects in whom the effects of GERD therapy on asthma outcomes were reported [Kiljander et al 1999;Boeree et al 1998;Levin et al 1998;Teichtahl et al 1996;Ford et al 1994;Meier et al 1994;Gustafsson et al 1992;Larrain et al 1991;Ekstrom et al 1989;Nagel et al 1988;Goodall et al 1981;Kjellen et al 1981]. Treatment with antireflux therapy did not consistently improve any one measure of pulmonary function in patients with asthma, but some studies did report objective improvement in single measurements of lung function such as FEV1 [Meier et al 1994;Larrain et al 1981], morning peak expiratory flow rates (PEF) [Levin et al 1998] and evening PEF [Teichtahl et al 1996;Goodall et al 1981].…”

A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease

“…There have been many studies dealing with asthma outcome and medical anti-reflux therapy. Field and Sutherland (1998) reviewed the previously published data on medical anti-reflux therapy with H 2 -receptor blockers (H 2 blockers), cimetidine (Goodall et al 1981;Larrain et al 1991) and ranitidine (Harper et al 1987;Nagel et al 1988;Ekstrom et al 1989;Gustaffson et al 1992), and with a proton pump inhibitor (PPI) omeprazole (Ford et al 1994;Meier et al 1994;Harding et al 1996;Teichtahl et al 1996), showing that asthma symptoms were improved. Kiljander (2003) suggested that, in the management of GERD-related asthma, PPIs other than omeprazole should be used at double the standard dose.…”

Oesophageal reflux and asthma

“…However, such treatment, even with H 2 blockers which effectively reduce gastric pH and nocturnal acid secretion, has shown only a small improvement in asthma symptoms, with a 15% improvement in nocturnal scores and a 10% reduction in bronchodilator use [35]. The dose of H 2 blocker was modest in each case, which may explain the relative lack of effect.…”