The use of proton pump inhibitors (PPI) has been identified as a significant risk factor for both future exacerbations and an accelerated annual decline in lung function in children with cystic fibrosis (CF), according to a new study published in the European Respiratory Journal.
Researchers carried out a longitudinal observational study of 545 children aged 5-18 years from the Dutch CF Registry. Annual change of FEV1 % predicted and pulmonary exacerbations at 1, 2, 3, 4, or 5 years later were the primary and secondary outcome measures.
Potential risk factors at baseline included sex, age, best FEV1 % predicted, best forced vital capacity % predicted, genotype, BMI z-score, pancreatic insufficiency, use of PPI, prophylactic antibiotics and inhaled corticosteroids, and CF-related diabetes.
The analysis found that PPI use was a significant risk factor for both an accelerated annual decline in FEV1% predicted and for future exacerbations.
The researchers studied whether the effect of PPI use increased with increasing duration of PPI use, and found that if the percentage of years of PPI use increased by 10%, the mean FEV1 % predicted decreased significantly faster over time.
Further, the risk of future exacerbations was significantly elevated in children with lower baseline % predicted FEV1, those using prophylactic inhaled antibiotics and those with a higher exacerbation rate in the past.
The authors note that the association between PPI use and lung disease progression requires further investigation.