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Treatment for Helicobacter Pylori Results in Improved Asthma Control in Patients With Moderate Persistent Asthma

Bombay Hospital and Medical Research Center, Mumbai, India

PURPOSE: Silent gastroesophageal reflux disease (GERD) coexists with and worsens asthma by multiple mechanisms. Role of H. pylori in GERD is controversial. A recent report suggests that eradication of H. pylori reduces recurrence rates of GERD. Serologic and case control studies have shown that H. pylori infection may be associated with development of chronic bronchitis. The aim of this study was to study the effect of treatment for H. pylori in moderate persistent asthma.

METHODS: Twenty-five consecutive patients with moderate (baseline PEFR 40–80%) persistent asthma presenting to the asthma clinic at our tertiary center were enrolled. Exclusion criteria: active peptic ulcer disease/ active dyspepsia, recent oral steroid use, and h/o smoking. After baseline spirometry, patients were randomized into two groups:

Group I - treated with standard therapy with metered dose inhalers administered via a spacer.

Group II - treated in addition with 4-drug therapy for H. pylori (metronidazole, doxycycline, omeprazole, bismuth) for 10 days.

All patients received individualized education.

Peak flow measurements were done at baseline and 2 weekly intervals for 8 weeks, under direct supervision by a physician, blinded to the patients’ group.

RESULTS: Both groups were well matched in terms of baseline PEFR.

Percent improvements in peak flow is shown in table 1

Group 1 (n = 12) Group 2 (n = 13) Week 2 28 +/-24 43 +/-35 Week 4 31 +/-25 50 +/-33 Week 8* 30 +/-24 60 +/-36

Values expressed as mean percentage change from baseline, +/- standard deviation

^* p < 0.05.

.

CONCLUSIONS: Treatment for H. pylori results in significant improvements in peak flow rates compared to standard therapy in moderate persistent asthma, even in patients with no dyspepsia.

CLINICAL IMPLICATIONS: H. pylori infection may be common in asthmatics, and worsen airway disease. Treatment for H. pylori may result in improved early asthma control.

DISCLOSURE: S. Subramanian, None.