Treatment for gastroesophageal reflux disease (GERD) using proton pump inhibitors (PPIs) does not increase pneumonia risk and also reduces risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, particularly in the post-treatment period, among patients with COPD, according to study findings published in Respiratory Research.

GERD frequently co-occurs with COPD. GERD can aggravate symptoms of COPD and trigger acute exacerbations of the breathing disorder. Theoretically, treatment of GERD with PPIs should reduce the risk for acute exacerbations and pneumonia in patients with comorbid COPD.

To analyze this theory, researchers conducted a nationwide, population-based, real-world, self-controlled case series analysis. Study participants had COPD, were aged 40 years and older, and had received PPI treatment for GERD for at least 14 consecutive days.

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Researchers further subdivided the patients into those with prevalent COPD and those with incident COPD. They identified 104,439 patients with prevalent COPD and 20,704 patients with incident COPD with concomitant GERD treated using PPIs. Around 54,689 of patients with prevalent COPD and 10,988 patients with incident COPD underwent a 90-day follow-up after PPI treatment discontinuation.

During PPI treatment for GERD, patients with prevalent COPD demonstrated a significantly lower risk for moderate acute exacerbations (incidence rate ratio [IRR], 0.89), but increased risk for severe acute exacerbations (IRR, 1.08). In contrast, following PPI treatment, risk for severe exacerbations decreased during the post-treatment period (IRR, 0.78).

During PPI treatment, patients with incident COPD demonstrated significantly lower risk for both moderate (IRR, 0.73) and severe COPD exacerbations (IRR, 0.91). Risk for severe exacerbations also decreased during the post-treatment follow-up period (IRR, 0.20).

Compared with baseline risk, risk for pneumonia did not significantly increase among patients with prevalent or incident COPD during PPI treatment (IRR, 1.00 and 0.92, respectively) or post-PPI treatment (IRR, 0.89 and 0.84, respectively).

“A significant reduction in the risk of moderate and severe exacerbation was noted after the PPI treatment compared with the non-treated period in patients with COPD with GERD,” the study authors said. “There was no evidence of an increased risk of pneumonia with PPI treatment.”

Study limitations include diagnosis of GERD without esophagogastroduodenoscopy or 24-hour pH monitoring, the possibility of patients receiving PPI treatment for reasons other than GERD, lack of available information on smoking status and body mass index risk factors, lack of assessment of the effects of different PPIs or dosing on end results, and lack of generalizability of results outside of South Korean ethnicity.


Kang J, Lee R, Lee SW. Effects of gastroesophageal reflux disease treatment with proton pump inhibitors on the risk of acute exacerbation and pneumonia in patients with COPDRespir Res. 2023;24(1):75. doi:10.1186/s12931-023-02345-1

This article originally appeared on Gastroenterology Advisor

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