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Meta-Analysis
. 2021 Aug 10;11(8):e043860.
doi: 10.1136/bmjopen-2020-043860.

Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis

Zhoude Zheng #  1 , Yunyun Luo #  2 , Jia Li  1 , Jinming Gao  3
Affiliations
Meta-Analysis

Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis

Zhoude Zheng et al. BMJ Open. .

Abstract

Objective: Asthma often coexists with gastro-oesophageal reflux disease (GERD). The effect of proton pump inhibitors (PPIs) treatment on asthma concomitant with GERD was inconsistent. This study aimed to assess whether PPIs treatment improved morning peak expiratory flow (mPEF) in asthma patients with GERD.

Data sources: PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library and ClinicalTrials.gov; hand searching for reference lists; contacted with authors if necessary.

Study selection: All eligible trials were randomised clinical trials comparing PPIs with placebo in asthma patients accompanying with GERD.

Results: Fourteen randomised clinical trials (2182 participants) were included. Overall, PPIs versus placebo did not affect mPEF in patients with asthma having GERD (weighted mean difference 8.68 L/min, 95% CI -2.02 to 19.37, p=0.11). Trial sequential analysis (TSA) further confirmed this finding (TSA adjusted 95% CI -1.03 to 22.25). Subgroups analyses based on the percentage of patients with symptomatic GERD≥95%, treatment duration >12 weeks also found no statistically significant benefit on mPEF. Similarly, analyses of secondary outcomes (evening PEF, forced expiratory volume in 1 s, asthma symptoms score, asthma quality of life score and episodes of asthma exacerbation) did not show significant difference between PPIs and placebo.

Conclusion: In this meta-analysis, PPIs therapy did not show a statistically significant improvement on mPEF in asthma patients having GERD, neither in subgroup with symptomatic GERD nor in subgroup with treatment duration >12 weeks. This analysis does not support a recommendation for PPIs therapy as empirical treatment in asthma patients with GERD.

Prospero registration number: CRD42020177330.

Keywords: asthma; oesophageal disease; therapeutics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of identification of eligible studies for inclusion.
Figure 2
Figure 2
Risk of bias summary displaying review authors’ judgements about each risk of bias item for each included study.
Figure 3
Figure 3
(A) Forest plot for morning peak expiratory flow (mPEF). (B) Forest plot for mPEF in subgroup of the percentage of subjects with symptomatic gastro-oesophageal reflux disease ≥95%. (C) Forest plot for mPEF in subgroups of treatment duration ≤12 weeks and >12 weeks. (D) Forest plot for mPEF in subgroups of different types of proton pump inhibitors. PPIs, proton pump inhibitors.
Figure 4
Figure 4
(A) Trial sequential analysis (TSA) of morning peak expiratory flow (mPEF). (B) TSA of mPEF in subgroup of the percentage of subjects with symptomatic gastro-oesophageal reflux disease ≥95%. (C) TSA of mPEF in subgroup of treatment duration >12 weeks. PPIs, proton pump inhibitors; RIS, required information size.
Figure 5
Figure 5
(A) Forest plot for evening peak expiratory flow. (B1) Forest plot for FEV1 % predicted. (B2) Forest plot for FEV1 (L). (C) Forest plot for asthma symptoms score. (D) Forest plot for asthma quality of life score. (E) Forest plot for episodes of asthma exacerbation. FEV1, forced expiratory volume in 1 s; PPIs, proton pump inhibitors.
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