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Silent Gastroesophageal Reflux Does Not Play a Role in Asthma, Study Shows ROCKVILLE, Md -- April 9, 2009 -- Adding esomeprazole (Nexium) to asthma therapy does not improve asthma symptoms or control in patients who do not have symptoms of gastroesophageal reflux (GER), according to a study published in the April 9 issue of the New England Journal of Medicine. The study, which found no difference between patients treated with esomeprazole and those who were not, suggests that silent GER does not play a role in asthma, as has previously been thought. The multicentre, randomised trial is the first to evaluate whether adding esomeprazole to asthma therapy might improve asthma control and quality of life in asthma patients who could have silent GER. Researchers followed 402 adults (mean age, 42 years) with poorly controlled asthma despite taking moderate or higher doses of inhaled corticosteroids. Participants reported that they did not have GER symptoms or that they had a history of GER but their symptoms were minimal and they were not taking anti-reflux medication. Researchers tested for GER with a probe to measure pH levels in the oesophagus and found that about 40% of participants had silent GER. Participants were randomised to esomeprazole 40 mg twice daily or a placebo for 6 months while continuing to take their asthma medications. They tracked their symptoms and asthma control through asthma diaries, and visited the research clinic monthly for lung function testing. They also completed standard quality-of-life questionnaires. Overall, the numbers and severity of asthma symptoms, and quality-of-life scores were similar between participants taking esomeprazole and participants who did not take the medication. In addition, the outcomes were similar among subgroups of participants, such as those with silent GER, those who were overweight or obese, and those who had frequent night awakenings due to asthma. "This study demonstrates that silent GER does not play a role in worsening asthma symptoms and control," said coauthor Robert A. Wise, MD, Johns Hopkins University School of Medicine, Bethesda, Maryland. "Based on these results, we also believe that doctors do not need to test for GER in asthma patients unless the patient is reporting symptoms of acid reflux." "This study fills a gap in our knowledge about the use of anti-reflux therapy in patients with poorly controlled asthma and it will help inform the next update of the asthma clinical guidelines," said Virginia Taggart, Division of Lung Diseases, National Heart, Lung, and Blood Institute (NHLBI), Rockville, Maryland. SOURCE: National Institutes of Health E-mail this page to a friend or colleague! To print, use this version