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. 2023 Mar 11;24(1):75.
doi: 10.1186/s12931-023-02345-1.

Effects of gastroesophageal reflux disease treatment with proton pump inhibitors on the risk of acute exacerbation and pneumonia in patients with COPD

Jieun Kang #  1 , Rugyeom Lee #  2   3 , Sei Won Lee  4
Affiliations

Effects of gastroesophageal reflux disease treatment with proton pump inhibitors on the risk of acute exacerbation and pneumonia in patients with COPD

Jieun Kang et al. Respir Res. .

Abstract

Background: Gastroesophageal reflux disease (GERD) has been suggested as a risk factor for acute exacerbation of chronic obstructive pulmonary disease (COPD). However, it remains undetermined whether proton pump inhibitor (PPI) treatment reduces the risk of exacerbation or affects the risk of pneumonia. This study aimed to evaluate the risks of both exacerbation and pneumonia following PPI treatment for GERD in patients with COPD.

Methods: This study used a reimbursement database of the Republic of Korea. Patients aged ≥ 40 years with COPD as a main diagnosis and who received PPI treatment for GERD at least for 14 consecutive days between January 2013 and December 2018 were included in the study. A self-controlled case series analysis was conducted to calculate the risk of moderate and severe exacerbation and pneumonia.

Results: A total of 104,439 patients with prevalent COPD received PPI treatment for GERD. The risk of moderate exacerbation was significantly lower during the PPI treatment than at baseline. The risk of severe exacerbation increased during the PPI treatment but significantly decreased in the post-treatment period. Pneumonia risk was not significantly increased during the PPI treatment. The results were similar in patients with incident COPD.

Conclusions: The risk of exacerbation was significantly reduced after PPI treatment compared with the non-treated period. Severe exacerbation may increase due to uncontrolled GERD but subsequently decrease following PPI treatment. There was no evidence of an increased risk of pneumonia.

Keywords: Acute exacerbation; Chronic obstructive pulmonary disease; Gastroesophageal reflux disease; Pneumonia; Proton pump inhibitor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram representing the self-controlled case series design of the study
Fig. 2
Fig. 2
Risk of study outcomes in patients with prevalent chronic obstructive pulmonary disease. In population 1, the IRRs of moderate and severe exacerbation and pneumonia during the PPI treatment period were calculated, compared to that at the baseline. Population 2 comprised patients with an observation period of at least 90 days after PPI discontinuation, and the IRRs of moderate and severe exacerbation and pneumonia during the PPI treatment and post-treatment periods were calculated. AE acute exacerbation, IRR incidence rate ratio, CI confidence interval, PPI proton pump inhibitor
Fig. 3
Fig. 3
Incidence rate ratios of study outcomes in patients with incident chronic obstructive pulmonary disease. In population 1, the IRRs of moderate and severe exacerbation and pneumonia during the PPI treatment period were calculated compared to that at the baseline. Population 2 comprised patients with an observation period of at least 90 days of after PPI discontinuation, and the IRRs of moderate and severe exacerbation and pneumonia during the PPI treatment and post-treatment periods were calculated. AE acute exacerbation, IRR incidence rate ratio, CI confidence interval, PPI proton pump inhibitor
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