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Journal club
M Mujahid Khan
09052013
bull GERDbull Literature reviewbull Critical appraisal
bull Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 23 of normal infants and it resolves spontaneously around 9-12 months of age
Gac Med Mex 2011147 Suppl 151-6 [Gastroesophageal reflux disease]
When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment anemia apnea wheezing or other chronic respiratory symptoms asthma recurrent pneumonia or sleeping problems
The pathophysiology of GERD is multifactorial and is associated with three potential abnormalities in LES motility incompetence of the LES inadequate gastric emptying and delayed gastric emptying
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull GERDbull Literature reviewbull Critical appraisal
bull Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 23 of normal infants and it resolves spontaneously around 9-12 months of age
Gac Med Mex 2011147 Suppl 151-6 [Gastroesophageal reflux disease]
When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment anemia apnea wheezing or other chronic respiratory symptoms asthma recurrent pneumonia or sleeping problems
The pathophysiology of GERD is multifactorial and is associated with three potential abnormalities in LES motility incompetence of the LES inadequate gastric emptying and delayed gastric emptying
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 23 of normal infants and it resolves spontaneously around 9-12 months of age
Gac Med Mex 2011147 Suppl 151-6 [Gastroesophageal reflux disease]
When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment anemia apnea wheezing or other chronic respiratory symptoms asthma recurrent pneumonia or sleeping problems
The pathophysiology of GERD is multifactorial and is associated with three potential abnormalities in LES motility incompetence of the LES inadequate gastric emptying and delayed gastric emptying
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment anemia apnea wheezing or other chronic respiratory symptoms asthma recurrent pneumonia or sleeping problems
The pathophysiology of GERD is multifactorial and is associated with three potential abnormalities in LES motility incompetence of the LES inadequate gastric emptying and delayed gastric emptying
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
The pathophysiology of GERD is multifactorial and is associated with three potential abnormalities in LES motility incompetence of the LES inadequate gastric emptying and delayed gastric emptying
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Proposed mechanisms of GERD-induced asthma include a vagally mediated reflex heightened bronchial reactivity microaspiration and immune system modification
The Relationship Between GERD and AsthmaKristi M Issac BS PharmD AE- Pharmacist 200934(7)30-35
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull The diagnosis of GERD can be confirmed by esophageal biopsy via upper gastrointestinal tract endoscopy esophageal manometry intraluminal impedance monitoring 24-h esophageal pH monitoring or intraluminal impedance monitoring combined with 24-h esophageal pH monitoring
Jornal Brasileiro de Pneumologia
J bras pneumol vol37 no5 Satildeo Paulo SeptOct 2011
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Literature review
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Two recent systematic reviews indicated that the prevalence of GERD symptoms is substantially higher in adults and children with asthma than in those without
bull The prevalence of GER diagnosed by pH monitoring
was 51 In another review which included 20 studies of children with asthma the mean age-adjusted prevalence of GERD was 228
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras pneumol vol37
no5 Satildeo Paulo SeptOct 2011
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull 20 articles that described 5706 patients (1966 through December 2008)
bull The average prevalence of GERD was 220 in asthma cases and 48 in controls
bull The conclusion was that there is a possible association between GERD and asthma in paediatric patients seen with asthma in referral settings
bull However because of methodologic limitations of existing studies the paucity of population-based studies and a lack of longitudinal studies several aspects of this association are unclear
Pediatrics 2010 Apr125(4)e925-30 doi 101542peds2009-2382 Epub 2010 Mar 29
Gastroesophageal reflux and asthma in children a systematic review Thakkar K Boatright RO Gilger MA El-Serag HB
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Prevalence studies have not produced sufficient evidence to determine whether the relationship between asthma and GERD is incidental or causal
bull Even longitudinal studies have been unable to answer this question
Gastroesophageal reflux disease and airway hyperresponsiveness concomitance beyond the realm of chance J bras
pneumol vol37 no5 Satildeo Paulo SeptOct 2011
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull In conclusion there are very few methodologically sound studies in this field with paediatric cases and more double-blind randomized controlled trials are necessary to decide whether we should use PPI in children with concomitant asthma and GERD
JInvestig Allergol Clin Immunol 200919(1)1-5
Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD A systematic review
Sopo SM Radzik D Calvani M
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Critical Appraisal
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Lansoprozole for children with difficult asthma
JAMA
American Lung association Asthma Clinical
Research Centre
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Clinical questionbull Patients 6- 17 years of age children with difficult asthmabull Intervention lansoprozolebull Comparison placebo bull Outcome Improvement in AQL
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Is the trial valid bull What are the results bull Will the results help locally
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Did the study ask a clearly focused question
1048713 Yes 1048713 Canrsquot tell 1048713 No
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Was this a randomised controlled trial (RCT) and was it appropriately so
Yes 1048713 Canrsquot tell 1048713 No
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Were participants appropriately allocated to intervention and control groups
Yes 1048713 Canrsquot tell 1048713 No
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
4 Were participants staff and study personnel lsquoblindrsquo to participantsrsquo study group
Yes Canrsquot Tell No
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Were all of the participants who entered the trial accounted for at its conclusion
Yes Canrsquot Tell No
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Date of download 552013Copyright copy 2012 American Medical Association
All rights reserved
From Lansoprazole for Children With Poorly Controlled Asthma A Randomized Controlled Trial
JAMA 2012307(4)373-380 doi101001jama20112035
Figure Legend
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Were the participants in all groups followed up and data collected in the same way
Yes Canrsquot Tell No
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Did the study have enough participants to minimise the play of chance
Yes Canrsquot Tell No
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull How are the results presented and what is the main result
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
Results
bull High prevalence of GERD in asthmabull No statistically significant difference in primary or
secondary outcomebull In the subgroup with positive pH study no treatment
effect of lansoprozole is observed bull Children treated reported more respiratory infection
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull How precise are these results
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull Were all important outcomes considered so the results can be applied
Yes Canrsquot Tell No
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
bull To date a precise mechanism link between gastro-oesophageal reflux and decline in asthma control has not been established
bull The results of trials of anti-reflux therapy are often disappointing especially in older children but an empirical trial is reasonable in younger children if the history is suggestive
An update on paediatric asthma -Gunilla Hedlin Jon Konradsen and Andrew Bush
Eur Respir Rev -Sept 2012
THANK YOU
THANK YOU
