February 1, 2012
Volume 7 - Issue 5        

DynaMed Weekly Update

For the week ending January 27, 2012  

Last week 390 articles were evaluated via DynaMed's Systematic Literature Surveillance and 214 were added to DynaMed content. 


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Lansoprazole Increases Adverse Events Without Improving Asthma Control in Children Without Symptomatic Gastroesophageal Reflux

 

Gastroesophageal reflux (GER) is common in children with asthma, and The National Heart, Lung and Blood Institute recommends treatment for GER symptoms, especially in children with frequent episodes of nocturnal asthma (Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94). Despite a lack of evidence, proton pump inhibitors (PPIs) are sometimes prescribed for children to improve asthma control, even in the absence of GER symptoms. A new randomized trial investigated the effects of a PPI on asthma outcomes in 306 children with asthma poorly controlled by inhaled corticosteroids. Children (mean age 11 years) were randomized to lansoprazole vs. placebo for 24 weeks. All children were free of GER symptoms. Exclusion criteria included any reflux symptoms requiring treatment, any previous use of PPIs or other reflux medications, or history of antireflux surgery. The lansoprazole dose was 15 mg/day for children weighing < 30 kg (66 lbs) and 30 mg/day for children ≥ 30 kg.

 

The primary outcome was change in score on the Asthma Control Questionnaire (ACQ), which assesses wheezing, shortness of breath, nocturnal symptoms, activity level, use of bronchodilators, and pulmonary function. A change of 0.5 points on the 6-point scale is considered clinically important (reduction indicates improvement). At 24 weeks, there was no significant difference in ACQ scores (mean reduction 0.1 points for lansoprazole vs. 0.2 points for placebo) (level 1 [likely reliable] evidence). Lansoprazole was associated with higher rates of upper respiratory infection (63% vs. 49%, p = 0.02, NNH 7), sore throat (52% vs. 39%, p = 0.02, NNH 7), and bronchitis (7% vs.2% p=0.04, NNH 20). There were no significant differences in asthma-related quality of life, or rate of episodes of poor asthma control.

 

A group of 115 children had esophageal pH measurements prior to randomization, and 43% were found to have asymptomatic gastroesophageal reflux. There were no significant differences in any asthma outcomes comparing lansoprazole vs. placebo in this subgroup (JAMA 2012 Jan 25;307(4):373).

 

For more information, see the Asthma in children topic in DynaMed.

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New topic added to DynaMed this week

ACE inhibitor overdose

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: February 1, 2012 
Expiration Date: February 1, 2013
Estimated Completion Time:
15 minutes
 
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
 
Faculty Information
 
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
 
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AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.

  

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102071W.

 
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