TABLE 2

Studies of gastro-oesophageal reflux treatment in COPD

First author [ref]
Study type
nTreatmentCOPD symptomsExacerbationsFEV1Other outcomes
Mokhlesi [106]
Prospective observational
100Antacids (43%)
PPI (28%)
H2RA (6%)
Treatment duration not specified
Resolution of chronic cough in 2% of patientsN/AUnchangedResolution of GORD symptoms in 2% of patients
Hasanoglu [107]
Prospective observational
30Ranitidine 50 mg intravenous, 2-h measurementN/AN/AUnchangedN/A
Sasaki [108]
RCT single-blind
100Lansoprazole (15 mg·day−1) versus usual careN/AFewer exacerbations (0.34 versus 1.18, p=0.03);
fewer patients experienced >1 exacerbation (24% versus 52%; p=0.004);
PPI therapy independently reduced risk of exacerbation (OR 0.23, 95% CI 0.08–0.62)
N/ATrend toward fewer common colds (1.22
versus 2.04) and less frequent common colds
<3 per year) with PPI therapy compared to control
Eryuksel [109]
Prospective observational
30Anti-reflux therapy (2 months)
PPI therapy
Reduced COPD symptoms (p<0.01)N/AN/AReduction in laryngopharyngeal reflux
symptoms (p<0.01);
improved laryngeal
examinations (p<0.001)
Hartwig [33]
Prospective observational
20Following bilateral lung transplantation,
Nissen fundoplication (<365 days post-transplant) undertaken in selected patients
UnchangedN/AFEV1 greater at 1 year with fundoplication compared to no fundoplication (8.8% difference)N/A
Hoppo [110]
Retrospective observational
11Pre-transplant Nissen fundoplicationUnchangedN/AImproved FEV1 and FVC % pred in overall group (separate outcomes for COPD not reported)N/A
Lee [111]
Prospective observational
17 498Acid suppressive medication (PPI or H2RA)N/AN/AN/AHigher incidence rate ratio of pneumonia
Ingebrigtsen [94]
Prospective observational
1259Daily use of acid inhibitory therapyN/AUnchangedN/AN/A
Su [112]
Prospective observational
17 423Acid suppressive therapy (PPI or H2RA)N/AN/AN/ALower risk of acute exacerbation (HR 0.31, 95% CI 0.20–0.50, p<0.0001) and mortality (HR 0.36, 95% CI 0.20–0.65, p=0.0007) with PPIs; no significant benefit observed for H2RAs

Abbreviations: FEV1: forced expiratory volume in 1 s; PPI: proton pump inhibitor; H2RA: histamine-2 receptor antagonist; GORD: gastro-oesophageal reflux; RCT: randomised controlled trial; FVC: forced vital capacity; HR: hazard ratio.