Objective The effect of antacid therapy for patients with COPD and gastroesophageal reflux disease (GERD) remains unclear. and 56,809.78 person-years, respectively, from 2000 to 2011. After multivariate adjustment, symptomatic GERD was associated with acute exacerbation (adjusted hazard ratio [HR]: 1.35, 95% CI: 1.23C1.48, test for non-normal distributions. bIncidence rate per 100 person-year. cExacerbation was measured from index date to the end of follow-up. dPrednisolone-equivalent fillings. eIncluded pneumonia-related antibiotics. Abbreviations: ED, emergency department; GERD, gastroesophageal reflux disease; ICU, rigorous care unit; OPD, outpatient department. Of notice, the COPD with symptomatic GERD cohort experienced a significantly greater risk of acute exacerbation than the COPD alone cohort in the KaplanCMeier analysis (log-rank test, em p /em 0.0001; Physique 1). After multivariate modification, symptomatic GERD was separately associated with severe exacerbation (altered HR: 1.35, 95% CI: 1.23C1.48, em p /em 0.0001; Desk S2). Likewise, the COPD with symptomatic GERD cohort acquired a considerably greater threat of mortality compared to the COPD by itself cohort (log-rank check, em p /em 0.0001; Body 2). Symptomatic GERD was separately connected with mortality (HR: 1.42, 95% CI: 1.25C1.61, em p Ezogabine supplier /em 0.0001; Desk S3). On the other hand, COPD with silent GERD cohort didn’t have a considerably greater threat of severe exacerbation and mortality compared to the COPD only cohort (Statistics 1 and ?and2).2). We discovered the following indie risk elements for both severe exacerbation and mortality in the COPD with symptomatic GERD cohort: later years, male sex, stroke, even more frequent emergency section trips for COPD, even more regular hospitalization for COPD, and even more medicines for COPD (Desks S4 and S5). Open up in another window Body 1 KaplanCMeier curve for cumulative threat of AECOPD in COPD sufferers. Note: There is a statistically factor between your COPD with symptomatic GERD and COPD by itself curves (log-rank check, em p /em 0.0001). Abbreviations: AECOPD, severe exacerbation of COPD; GERD, gastroesophageal reflux disease. Open up in another window Body 2 KaplanCMeier curve for success possibility in COPD sufferers. Note: There is a statistically factor between your COPD with symptomatic GERD and COPD by itself curves (log-rank check, em p /em 0.0001). Abbreviation: GERD, gastroesophageal reflux disease. Ramifications of PPIs/H2RAs on severe exacerbations and mortality In the COPD with symptomatic GERD group, a high dose of PPIs (R1 DDD per day) was associated with a significantly lower risk of acute exacerbation (HR 0.31, 95% CI: 0.20C0.50, em p /em 0.0001) compared with a low dose of PPIs ( 1 DDD per day). Furthermore, a high dose of PPIs was associated with a significantly lower risk of mortality (HR 0.36, 95% CI: 0.20C0.65, em p /em =0.0007) compared with a low dose of PPIs. In contrast, a high dose of H2RAs (1 DDD Ezogabine supplier per day) was associated with an insignificantly lower risk of acute exacerbation (HR 0.75, 95% CI: 0.47C1.21) and mortality (HR 0.80, 95% CI: 0.39C1.63) compared with a low dose of PPIs ( 1 DDD per day; Table 3). Table 3 Association between PPIs/H2RAs use and risk of acute exacerbation and mortality in COPD with symptomatic GERD thead th rowspan=”2″ valign=”top” align=”left” colspan=”1″ Variables /th th colspan=”2″ valign=”top” align=”left” rowspan=”1″ Acute exacerbation hr / /th th colspan=”2″ valign=”top” align=”left” rowspan=”1″ Mortality hr / /th th valign=”top” align=”left” rowspan=”1″ colspan=”1″ HR (95% CI)a /th th valign=”top” align=”left” rowspan=”1″ colspan=”1″ em p /em -value /th th valign=”top” align=”left” rowspan=”1″ colspan=”1″ HR (95% CI)a /th th valign=”top” align=”left” rowspan=”1″ colspan=”1″ em p /em -value /th /thead PPIsb? 1 DDD per dayReferenceReference?1 DDD per day0.31 (0.20C0.50) 0.00010.36 (0.20C0.65)0.0007H2RAsb? 1 DDD per dayReferenceReference?1 DDD per day0.75 (0.47C1.21)0.24150.80 (0.39C1.63)0.5375 Open in a separate window Notes: aAdjusted for all those factors shown in Table 1; all elements Ezogabine supplier with em p /em 0.1 in univariate analyses had been contained in the Cox multivariate evaluation. bMedications were examined as time-dependent covariates (period period: every 3 months), and had been followed for an interval of just one 1 12 months following the index time. Abbreviations: DDD, described daily dosage; GERD, gastroesophageal reflux disease; H2RAs, histamine2-receptor antagonists; HR, threat proportion; PPIs, proton pump inhibitors. Desk 4 displays the outcomes of the consequences of PPIs/H2RAs on acute mortality and exacerbation in the sufferers with COPD. Weighed against the COPD by itself group, the sufferers in the COPD with symptomatic GERD group who had been treated with low-dose PPIs or H2RAs had been connected with a considerably higher threat of severe exacerbation (HR 1.75, 95% CI: 1.50C2.03, em p /em 0.0001) and mortality (HR 1.97, 95% CI: 1.56C2.50, em p /em 0.0001). Furthermore, the Rabbit Polyclonal to CXCR4 sufferers in the COPD with symptomatic GERD group who had been treated with high-dose H2RAs had been still connected with an insignificantly higher threat of severe exacerbation (HR 1.28; 95% CI: 0.91C1.80) and mortality (HR 1.33, 95% CI: 0.78C2.25) than those in the COPD alone group. In contrast, the individuals in the COPD with symptomatic GERD group.