Proton pump inhibitors for chronic obstructive pulmonary disease

Area of Science:

• Pulmonary Medicine
• Gastroenterology
• Clinical Pharmacology

Background:

• Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition associated with significant mortality and reduced quality of life.
• COPD exacerbations are a major clinical concern, and gastroesophageal reflux disease (GERD) is a common comorbidity.
• Pulmonary microaspiration of gastric acid is a potential mechanism linking GERD to COPD exacerbations, suggesting acid suppression might be beneficial.

Purpose of the Study:

• To evaluate the efficacy and safety of proton pump inhibitors (PPIs) for managing chronic obstructive pulmonary disease (COPD).
• To focus on COPD-specific outcomes, including exacerbation rates and adverse events.

Main Methods:

• A systematic review of parallel-group and cluster-randomised controlled trials (RCTs) comparing oral PPIs with placebo or usual care in adults with COPD.
• Searches conducted in the Cochrane Airways Register of Trials and other clinical trial registers up to May 2020.
• Data extraction and risk of bias assessment performed by two independent reviewers, with discrepancies resolved by a third.

Main Results:

• One multicentre RCT involving 103 adults with COPD was included, comparing lansoprazole plus usual care against usual care alone over 12 months.
• The study reported a reduced risk ratio (0.46) for COPD exacerbations in the PPI group and a significantly lower mean annual exacerbation frequency (0.34 vs 1.18).
• No significant difference was observed in the incidence of the common cold; data on pneumonia, serious adverse events, quality of life, and lung function were not reported. Evidence certainty was rated as low to very low.

Conclusions:

• Current evidence is insufficient to establish the efficacy and safety of PPIs for COPD management.
• The single included trial had a small sample size and low to very low certainty evidence.
• Larger, high-quality studies are required to investigate the impact of PPIs on major clinical outcomes in COPD patients, including exacerbations and adverse events.