Gastroesophageal reflux disease and childhood asthma

Area of Science:

• Pediatric Pulmonology
• Gastroenterology
• Clinical Therapeutics

Background:

• Gastroesophageal reflux disease (GERD) is frequently observed in children with asthma, often without symptoms.
• Current clinical practice frequently involves treating pediatric asthma patients with GERD medications, guided by national guidelines.
• This practice is based on an unproven assumption that GERD significantly impacts asthma control.

Purpose of the Study:

• To evaluate the evidence supporting the routine use of anti-GERD medications for poorly controlled asthma in children.
• To determine if GERD treatment improves asthma outcomes in pediatric populations.

Main Methods:

• Review of clinical studies and controlled trials examining the relationship between GERD and asthma control in children.
• Analysis of data from a recent large controlled clinical trial involving proton-pump inhibitor (PPI) treatment.

Main Results:

• GERD is highly prevalent in children with asthma (up to 80%), with many remaining asymptomatic.
• No conclusive evidence demonstrates that asymptomatic GERD affects asthma control.
• Treatment of GERD, including with PPIs, has not shown substantial improvement in asthma outcomes in controlled trials.
• A recent trial indicated PPIs were ineffective and associated with increased respiratory infections.

Conclusions:

• The current body of evidence does not endorse the routine prescription of anti-GERD medications for children with poorly controlled asthma.
• Further research, including large controlled trials in children with symptomatic GERD and asthma, is needed to clarify potential benefits.
• In cases where children have both symptomatic GERD and asthma, the potential benefits of treatment may warrant consideration despite unproven efficacy.