Disclosures: Wang reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
February 09, 2021
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PPI use increases risk for asthma by 57% in children

Disclosures: Wang reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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Risk for asthma in children grew with use of proton pump inhibitors compared with no-use, according to a study published in JAMA Pediatrics.

“In this nationwide cohort study, we observed a significant 57% increased risk of asthma among children who initiated PPI use compared with those who did not initiate PPI use,” Yun-Han Wang, MSc, BPharm, from the clinical epidemiology division, department of medicine Solna, Karolinska Institute, Stockholm, Sweden, and colleagues wrote. “An in-creased risk was observed across all age groups and was greatest in infants and toddlers younger than 2 years.”

In Sweden, Wang and colleagues used nationally collected registry data to identify 80,870 pairs of children and adolescents whom researchers matched by age and propensity score. Each pair included one child who initiated PPI use and one who did not. Investigators examined the risk for incident asthma at a median follow up of 3 years.

Results show that children who used PPIs had a higher incidence of asthma (21.8 events per 1,000 person-years vs. 14 events per 1,000 person-years; HR = 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),” Wang and colleagues wrote.

Investigators reported HRs for individual PPIs were 1.64 for esomeprazole (95% CI, 1.5-1.79), 1.49 for lansoprazole (95% CI, 1.25-1.78), 1.43 for omeprazole (95% CI, 1.35-1.51) and 2.33 for pantoprazole (95% CI, 1.35-1.51).

According to analyses of the timing of asthma onset after initiation of PPIs, HRs were 1.62 for 0 to 90 days (95% CI, 1.42-1.85), 1.73 for 91 to 180 days (95% CI, 1.52-1.98) and 1.53 for 181 days to end of follow-up (95% CI, 1.45-1.62). The correlation remained consistent through all sensitivity analyses such has high-dimensional propensity score matching (HR, 1.48; 95% CI, 1.41-1.55).

Proton pump inhibitors should be prescribed to children only when clearly indicated, weighing the potential benefit against potential harm,” the researchers wrote.