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ppi reduces exacerbations of copd
Embargoed For Release
Dr. Anka Stegmeier-Petroianu
Chronic obstructive pulmonary disease
Proton pump inhibitor reduces risk of exacerbations
– Proton pump inhibitors (PPIs), a class of drugs used in the
treatment of gastroduodenal ulcers and gastroesophageal reflux disease, may
also be of benefit to patients suffering from chronic obstructive pulmonary
disease (COPD), suggests a Japanese study presented at the 19th Annual
Congress of the European Respiratory Society.
Patients affected by COPD not only suffer from shortness of breath due to an
irreversible limitation of airflow; they are predisposed to recurring
respiratory infections, which in turn aggravate their condition—so-called
exacerbations—with the risk of lung function deteriorating below the
individual patient’s baseline prior to the exacerbation.
Previous experimental studies on tracheal epithelial cells had shown that the
proton pump inhibitor lansoprazole inhibits production of proinflammatory
cytokines also believed to be implicated in the pathogenetic mechansim of
In this new study, Japanese researchers enrolled 103 patients with confirmed
chronic obstructive pulmonary disease. All patients continued their usual
medications with bronchodilators such as theophylline, beta-agonists and
inhaled anticholinergic agents throughout the observation period, and some
of the patients were also on inhaled corticosteroids.
Patients who had symptoms suggestive of gastroesophageal reflux disease
were excluded from the study; in fact, all patients had also undergone
endoscopy to exclude any gastroduodenal disease.
In the prospective study with 100 analyzable results, 50 patients were in the active group receiving a PPI(lansoprazole 15 mg /d) and 50 patients were in the control group over a period of 12 months. During this period any symptoms suggestive of a common cold, such as sneezing, runny nose, headache, sore throat, or cough, were recorded and rated with a symptom score from 0 to 30. The diagnosis of ―common cold‖ was established if a symptom score higher than five was recorded. The criterion of acute exacerbation was met if patients experienced an acute worsening of COPD symptoms necessitating a change in regular medication, such as the addition of an antibiotic or a course of systemic corticosteroids. In the PPI group, the absolute number of common colds was lower than in the control group, but the difference (1.22 vs 2.04) was not statistically significant. However, the total number of exacerbations over the one-year study period was significantly lower in the PPI group than in the control group (0.34 vs 1.18, p < 0.001). After adjustment for confounding factors such as age, previous influenza vaccination, and COPD stage, use of a PPI was independently and significantly associated with a lower risk of having frequent common colds (> 3 per year) and with a lower risk of COPD exacerbations.
―In as many as half the infections of COPD-patients, common colds
caused by rhinoviruses seem to be the trigger to exacerbations,‖ explains Takahiko Sasaki
, MD, PhD, from Tohoku University Graduate School of
Medicine, Sendai, Japan. Lansoprazole was found to modulate inflammatory
responses after rhinovirus infection. ICAM-1 is the main infection receptor
used by rhinoviruses. Lansoprazole not only in-vitro suppresses ICAM-1 but
also decreases production of proinflammatory cytokines, thereby preventing
The risk of catching common colds frequently (more than three times per
year) was reduced by 72% in the group receiving a proton pump inhibitor, as
compared to controls.
In fact, the risk of COPD exacerbations was significantly reduced, by 77%.
―These findings led us to believe that, when added to conventional therapy,
low-dose proton pump inhibition could prevent exacerbations in COPD-
patients‖ says Dr. Sasaki.
The ERS is an organization of and for physicians, health professionals, and
scientists that advances lung health through of education, research,
advocacy and practice support that foster excellence in the field of
respiratory medicine. For more information, see
Abstract No: 603 Title: The proton pump inhibitor reduces the frequency of exacerbations in patients with chronic obstructive pulmonary disease (COPD) Author contact
NIH Public Access Author Manuscript Oral Dis . Author manuscript; available in PMC 2008 February 28. Oral Dis . 2007 November ; 13(6): 508–512. Oral biofilms, periodontitis, and pulmonary infections S Paju 1,2 and FA Scannapieco 3 1Institute of Dentistry, University of Helsinki, Helsinki, Finland 2Department of Oral and MaxillofacialDiseases, Helsinki University Central Hospital,
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