Proton pump inhibitors use is associated with a lower risk of acute exacerbation and mortality in patients with coexistent COPD and GERD
Received 22 November 2017
Accepted for publication 12 April 2018
Published 19 September 2018 Volume 2018:13 Pages 2907—2915
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Prof. Dr. Chunxue Bai
Vincent Yi-Fong Su,1–3 Han-Fang Liao,4 Diahn-Warng Perng,3,5 Yueh-Ching Chou,4,6,7 Chia-Chen Hsu,6 Chia-Lin Chou,4,6 Yuh-Lih Chang,4,6 Jiin-Cherng Yen,4 Tzeng-Ji Chen,3,8,9 Ting-Chun Chou4,6
1Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan; 2Institute of Clinical Medicine, 3Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 4Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 6Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; 7School of Pharmacy, Taipei Medical University, Taipei, Taiwan; 8Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 9Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
Objective: The effect of antacid therapy for patients with COPD and gastroesophageal reflux disease (GERD) remains unclear.
Patients and methods: This nationwide population-based study was conducted using data from Taiwan’s National Health Insurance Research Database, and enrolled COPD patients with or without GERD. Patients with COPD who were not prescribed COPD medications were excluded. Patients with GERD who underwent upper gastrointestinal endoscopy or 24-hour pH monitoring and received at least 1 antacid were enrolled as symptomatic GERD group. The primary endpoint was acute exacerbation and mortality.
Results: This study included 3,485 patients with COPD and symptomatic GERD, and 13,938 patients with COPD alone and covered 12,806.57 and 56,809.78 person-years, respectively, from 2000 to 2011. After multivariate adjustment, symptomatic GERD was associated with acute exacerbation (adjusted hazard ratio [HR]: 1.35, 95% CI: 1.23–1.48, p<0.0001) and mortality (HR: 1.42, 95% CI: 1.25–1.61, p<0.0001). In the COPD with symptomatic GERD group, use of proton pump inhibitors was associated with a lower risk of acute exacerbation and mortality (acute exacerbation, HR 0.31, 95% CI: 0.20–0.50, p<0.0001; mortality, HR 0.36, 95% CI: 0.20–0.65, p=0.0007), whereas no significant benefit was observed for histamine2-receptor antagonists.
Conclusion: Use of proton pump inhibitors was associated with a lower risk of acute exacerbation and mortality in the patients with COPD and symptomatic GERD.
Keywords: GERD, COPD, acute exacerbations, death
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