Abstract：
Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well studied. We aimed to evaluate the relationship between PPI use and asthma exacerbation using a large administrative claims database in Japan. We conducted a self-controlled case series using the JMDC Claims Database (JMDC, Inc., Tokyo, Japan). The cases included adult patients with asthma who were prescribed PPI and experienced at least one outcome event between January 2015 and December 2019. The primary outcome was the composite outcome of hospital admissions and unscheduled outpatient clinic visits due to asthma exacerbation. We also conducted stratified analyses based on PPI generation, the presence of gastroesophageal reflux disease (GERD), asthma severity, and the number of allergic comorbidities. A total of 7379 eligible patients were included in the study. PPI prescription was associated with a decrease in the composite outcomes (incidence rate ratio, 0.90; 95% confidence interval, 0.87-0.93). However, PPI prescriptions did not affect the outcomes of hospital admissions (incidence rate ratio, 1.34; 95% confidence interval, 0.86-2.10). Stratified analyses based on PPI generation, the presence of GERD, asthma severity (except for severe asthma), and the number of allergic comorbidities yielded consistent results. PPI use was associated with a moderate decrease in asthma exacerbation, regardless of the patient profile. However, this effect was not as strong as the prevention of hospital admissions, and outcome events were not prevented in patients with severe asthma.
摘要：
质子泵抑制剂（PPI）用于治疗哮喘症状，如咳嗽；然而，PPI对哮喘加重的有效性尚未得到很好的研究.我们旨在使用日本的大型行政索赔数据库评估PPI使用与哮喘恶化之间的关系。我们使用JMDC索赔数据库(JMDC，Inc.,东京,日本）。这些病例包括成人哮喘患者，他们在2015年1月至2019年12月期间服用PPI并经历至少一次结局事件。主要结局是因哮喘加重而入院和计划外门诊就诊的复合结局。我们还根据PPI的产生进行了分层分析，胃食管反流病（GERD）的存在，哮喘严重程度，以及过敏性合并症的数量。总共7379名符合条件的患者被纳入研究。PPI处方与综合结局的下降相关(发生率比，0.90；95%置信区间，0.87-0.93）。然而,PPI处方不影响住院患者的结果(发病率比，1.34；95%置信区间，0.86-2.10)。基于PPI生成的分层分析，GERD的存在,哮喘严重程度（严重哮喘除外），和过敏性合并症的数量产生一致的结果。PPI使用与哮喘加重的中度减少有关，不管病人的情况如何。然而,这种效果不如预防住院那么强，重度哮喘患者的结局事件未得到预防.
