Investigators from Karolinska Institutet, Stockholm, Sweden, conducted a retrospective cohort study to assess the association between proton pump inhibitor (PPI) use and asthma in children. For the study, the investigators linked data from several national Swedish registries that included health care use, diagnoses, drug prescriptions, and demographic information on all citizens. Swedish children who were <18 years old at some point between January 2007 and June 2016 were eligible for inclusion in the study. Those who initiated PPI use during the study period, with no record of a PPI prescription in the prior year, constituted 1 cohort. Children with a history of asthma prior to initiation of PPI use were excluded. Each child in this PPI initiator cohort was matched 1:1 with a “non-initiator” who did not have any prescriptions for PPIs. Matching was done with the use of a propensity score based on age, socioeconomic characteristics, comorbidities, use of health care, and other medication usage. For each pair of participants an index date was identified and defined as the date of the initial prescription for the PPI initiator. Follow-up continued for up to 3 years. The primary study outcome was incident asthma, defined as a first diagnosis of asthma or prescription for ≥2 prescriptions for asthma medications, after the index date. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for development of asthma among PPI initiators compared to non-initiators and for exposure to individual PPI medications. Subgroup analyses were conducted among children in different age categories.
Data were analyzed on 80,870 pairs of initiators and non-initiators; the mean age of study participants was 12.9 years, and 63% were girls. Median follow-up was 3 years. The incidence rate of asthma was 21.8 per 1,000 person-years in PPI initiators compared to 14.0 per 1,000 person-years among non-initiators (HR, 1.57; 95% confidence interval [CI], 1.49, 1.64). There also was a significantly increased risk for developing asthma associated with use of each individual PPI including esomeprazole, lansoprazole, omeprazole, and pantoprazole, with HRs ranging from 1.43 to 2.33. Although PPI initiators from each age group were at significantly increased risk for developing asthma, the risk was highest among those <6 months old (HR, 1.83; 95% CI, 1.65, 2.03) and in children 6 months to <2 years old (HR, 1.91; 95% CI, 1.65, 2.22); risk was significantly associated with age category (P <0.001).
The authors conclude that initiation of PPI use was associated with an increased risk for development of asthma in children.
Dr Lesser has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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