Proton Pump Inhibitors: Promising Role in the Prophylaxis and Symptom Control of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD), the third leading cause of death worldwide and the fifth-ranked cause of chronic disability is usually associated with significant concomitant chronic diseases, Gastroesophageal Reflux Disease (GERD) being the commonest. Exacerbations of COPD (AECOPD) are episodes of worsening of symptoms, the frequency of which increases with the severity of COPD. AECOPD is triggered mainly by respiratory infections, bacterial or viral or both. Human rhinoviruses (HRV) are the top viral pathogen in triggering AECOPD, and experimental infection has provided significant new evidence in establishing a causal relationship between virus infections and AECOPD.

Proton pump inhibitors (PPI), the most potent acid suppressants, are commonly prescribed for isolated GERD or GERD complicating COPD. There has been a breakthrough in Pulmonary Medicine in that PPI, in addition to their well proven role in acid suppression, has emerged as a promising interventional tool in the prophylaxis and symptom control of AECOPD. This efficacy is not limited to patients with COPD complicated by GERD, since PPI also independently and significantly reduced the risk of developing frequent AECOPD in those with COPD alone, delaying disease progression and improving clinical outcomes.

Although the studies conducted so far regarding effectiveness of PPI had promising results, current evidence is insufficient to determine to what extent their long-term use is safe. Large scale multi-center studies are warranted to assess their long-term safety profile and clinical outcomes.

The objective of this study is to identify a possible role of PPI in prophylaxis and symptom control of AECOPD.