00doc

Acid suppression does not change respiratory symptoms in children with
asthma and gastro-oesophageal reflux disease
K Størdal1, G B Johannesdottir2, B S Bentsen2, P K Knudsen2, K C L Carlsen2,
O Closs3, M Handeland4, H K Holm5 and L Sandvik6
1 Dept of Paediatrics, Østfold County Hospital, 1602 Fredrikstad, Norway
2 Dept of Paediatrics, Ullevaal University Hospital, 0407 Oslo, Norway
3 Dept of Paediatrics, Ahus University Hospital, 1474 Nordbyhagen, Norway
4 Dept of Paediatrics, Vestfold Hospital, 3103 Tønsberg, Norway
5 Dept of Paediatrics, Oppland County Hospital, 2629 Lillehammer, Norway
6 Center for Clinical Research, Ullevaal University Hospital, 0407 Oslo,
Norway

Correspondence to:
Dr K Størdal
Dept of Paediatrics, Østfold Central Hospital, 1602 Frederikstad, Norway;
ketil.stoerdal@c2i.net

Background: Epidemiological studies have shown an association between
gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid
perfusion may cause bronchial constriction. However, no causative relation
has been proven.

Aim: To assess whether acid suppression would lead to reduced asthma
symptoms in children with concomitant asthma and GORD.

Methods: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29
males) with asthma and a reflux index 5.0 assessed by 24 hour oesophageal pH
monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg
daily or placebo. The groups were similar in age, gender, mean reflux index,
and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze,
symptoms at night, in the morning, and during exercise) and quality of life
(PAQLQ). Secondary endpoints were changes in lung function and the use of
short acting bronchodilators. At the end of the study a repeated pH study
was performed to confirm the efficacy of acid suppression.

Results: The change in total symptom score did not differ significantly
between the omeprazole and the placebo group, and decreased by 1.28 (95%
CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ
score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group
compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung
function and use of short acting bronchodilators were similar in the groups.
The acid suppression was adequate (reflux index <5.0) under omeprazole
treatment.

Conclusion: Omeprazole treatment did not improve asthma symptoms or lung
function in children with asthma and GORD.