In a recent publication in Respiratory Research, researchers explored the risks of both exacerbation and pneumonia following proton pump inhibitor (PPI) treatment for gastroesophageal reflux disease (GERD) in patients with chronic obstructive pulmonary disease (COPD).

To accomplish this, the researchers conducted a nationwide, population-based, real-world, self-controlled case series analysis. The coprimary outcomes were risks of acute moderate and severe COPD exacerbation and pneumonia.

Study participants had COPD, were aged 40 years and older, and had received PPI treatment for GERD for at least 14 consecutive days. The self-controlled case series analysis was conducted to compute the risk of moderate and severe exacerbation and pneumonia.

The researchers categorized the participants as population 1 or 2, corresponding to the presence of the observation period after PPI discontinuation (posttreatment period). In population 1, using the baseline period as a reference, the risks of moderate exacerbation, severe exacerbation, and pneumonia in the treatment period were calculated as incident rate ratios (IRRs). In population 2, IRRs of moderate and severe exacerbation and pneumonia in the posttreatment periods were computed in addition to the risks during the treatment period.

A total of 104,439 patients with prevalent COPD and 20,704 patients with incident COPD and concomitant GERD treated using PPIs were identified. Of these, 54,689 patients with prevalent COPD and 10,988 patients with incident COPD underwent a 90-day follow-up after PPI treatment discontinuation. In population 1, men accounted for 54.6%, and population 2 had 55.0% men. Baseline characteristics were comparable between both populations. Patients had multiple comorbidities, such as asthma, hyperlipidemia, hypertension, and diabetes.

The analysis revealed that the risk of moderate exacerbation was significantly lower during the PPI treatment than at baseline, and the risk of severe exacerbation increased during the PPI treatment but significantly decreased in the posttreatment period. Pneumonia risk was not significantly increased during the PPI treatment, and the results were comparable in patients with incident COPD.

The authors noted that additional research is necessary to ascertain whether variances in acid-suppression potency according to PPI types or doses lead to differences in the exacerbation risk.

The authors wrote, “In conclusion, a significant reduction in the risk of moderate and severe exacerbation was noted after the PPI treatment compared with the non-treated period in patients with COPD with GERD. Although severe exacerbation may increase due to uncontrolled GERD, it subsequently decreases following the PPI treatment. There was no evidence of an increased risk of pneumonia with PPI treatment. GERD is one of the common comorbidities in COPD, and our large-sized real-world study indicated the positive impact of its management on exacerbation.”

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