Therapy with proton-pump inhibitors for gastroesophageal reflux disease does not reduce the risk for severe exacerbations in COPD

Background and objectiveGastroesophageal reflux disease (GERD) symptoms are associated with a higher risk of chronic obstructive pulmonary disease (COPD) exacerbation. We hypothesize that treatment with proton pump inhibitors reduces the risk of exacerbation in patients with stable COPD. MethodsA total of 638 patients with stable COPD for 6weeks, 10pack-years of smoking and Global Initiative for Chronic Obstructive Lung Disease II-IV seeking care in tertiary hospitals in eight European countries in the Predicting Outcome using Systemic Markers in Severe Exacerbations-COPD cohort was prospectively evaluated by us. Comorbidities including associated medical treatment were assessed at baseline, at exacerbation and at biannual visits. Median observation time was 24months. The primary study outcomes were exacerbation and/or death. ResultsA total of 85 (13.3%) of COPD patients were on anti-GERD therapy. These patients had higher annual and higher severe exacerbation rates (P=0.009 and P=0.002), decreased quality of life (SF-36: activity score P=0.004, St. George's Respiratory Questionnaire: physical functioning P=0.013 and social functioning P=0.007), higher body mass airflow obstruction, dyspnea and exercise capacity index (P=0.033) and Modified Medical Research Council scores (P=0.002), shorter 6-min walking distance (P=0.0004) and a higher adjusted Charlson score (P