Related Experiment Video
Updated: Nov 18, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Association Between Proton Pump Inhibitor Use and Risk of Asthma in Children
Yun-Han Wang1, Viktor Wintzell1, Jonas F Ludvigsson2,3,4,5
1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Proton pump inhibitor (PPI) use in children is linked to a higher risk of developing asthma. This association was observed across various age groups, particularly in infants and toddlers, highlighting the need for careful consideration of PPI prescriptions.
Area of Science:
- Pediatric medicine
- Pulmonology
- Pharmacology
Background:
- Proton pump inhibitor (PPI) use in children has significantly increased.
- Concerns exist regarding a potential link between PPI use and increased asthma risk in pediatric populations.
Purpose of the Study:
- To investigate the association between the initiation of proton pump inhibitor (PPI) use and the subsequent risk of asthma diagnosis in children and adolescents.
Main Methods:
- A nationwide cohort study in Sweden (2007-2016) matched 80,870 children initiating PPI use with non-users.
- Propensity score matching and Cox proportional hazards regression were employed to analyze incident asthma risk.
- Median follow-up was 3.0 years.
Main Results:
- Initiation of PPI use was associated with a 57% increased risk of asthma (HR, 1.57; 95% CI, 1.49-1.64).
- The risk was elevated across all pediatric age groups, with the highest hazard ratios observed in infants and toddlers.
- Consistent associations were found across sensitivity analyses and individual PPIs.
Conclusions:
- Proton pump inhibitor (PPI) initiation in children is associated with an increased risk of asthma.
- PPIs should be prescribed judiciously in pediatric populations, balancing potential benefits against identified risks.
Importance:
The use of proton pump inhibitors (PPIs) in children has increased substantially in recent years, concurrently with emerging concerns that these drugs may increase the risk of asthma. Whether PPI use in the broad pediatric population is associated with increased risk of asthma is not known.
Objective:
To investigate the association between PPI use and risk of asthma in children.
Design, Setting, And Participants:
This nationwide cohort study collected registry data in Sweden from January 1, 2007, to December 31, 2016. Children and adolescents 17 years or younger were matched by age and propensity score into 80 870 pairs of those who initiated PPI use and those who did not. Data were analyzed from February 1 to September 1, 2020.
Exposures:
Initiation of PPI use.
Main Outcomes And Measures:
The primary analysis examined the risk of incident asthma with a median follow-up to 3.0 (interquartile range, 2.1-3.0) years. Cox proportional hazards regression was used to estimate hazard ratios (HRs).
Results:
Among the 80 870 pairs (63.0% girls; mean [SD] age, 12.9 [4.8] years), those who initiated PPI use had a higher incidence rate of asthma (21.8 events per 1000 person-years) compared with noninitiators (14.0 events per 1000 person-years), with an HR of 1.57 (95% CI, 1.49-1.64). The risk of asthma was significantly increased across all age groups and was highest for infants and toddlers with an HR of 1.83 (95% CI, 1.65-2.03) in the group younger than 6 months and 1.91 (95% CI, 1.65-2.22) in the group 6 months to younger than 2 years (P < .001 for interaction). The HRs for individual PPIs were 1.64 (95% CI, 1.50-1.79) for esomeprazole, 1.49 (95% CI, 1.25-1.78) for lansoprazole, 1.43 (95% CI, 1.35-1.51) for omeprazole, and 2.33 (95% CI, 1.30-4.18) for pantoprazole. In analyses of the timing of asthma onset after PPI initiation, the HRs were 1.62 (95% CI, 1.42-1.85) for 0 to 90 days, 1.73 (95% CI, 1.52-1.98) for 91 to 180 days, and 1.53 (95% CI, 1.45-1.62) for 181 days to end of follow-up. The association was consistent through all sensitivity analyses, including high-dimensional propensity score matching (HR, 1.48; 95% CI, 1.41-1.55).
Conclusions And Relevance:
In this cohort study, initiation of PPI use compared with nonuse was associated with an increased risk of asthma in children. Proton pump inhibitors should be prescribed to children only when clearly indicated, weighing the potential benefit against potential harm.
Related Concept Videos
01:29Asthma-I: Introduction
01:19Antiasthma Drugs: Leukotriene Modifiers
Leukotriene modifiers work through two distinct mechanisms:
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes: