Study: Cholesterol Drugs May Worsen Asthma

Experts Say the Findings Contradict Some Earlier Studies on the Effects of Statin Drugs

Nov. 5, 2011 -- People with asthma may find that their breathing gets worse after they start a statin drug to lower cholesterol, a small new study shows.

Asthma experts say the finding is a surprise because some previous studies have shown that statin drugs have anti-inflammatory properties beyond their cholesterol-lowering effects that may help conditions like asthma.

So, researchers are not building a case right now for you to change your medications, but to talk to your doctor if you have asthma and high cholesterol. They also say this is a call to do more research on the topic.

The new study -- being presented at the annual meeting of the American College of Allergy, Asthma, and Immunology in Boston -- followed 40 asthma patients who were treated at the same California clinic for one year.

Twenty patients had just begun statin medications to lower cholesterol at the start of the study. Twenty others who were not taking statins were followed for comparison. All were nonsmokers who had been diagnosed with asthma for at least five years.

Patients were excluded from the study if an asthma attack had landed them in the hospital or emergency room in the eight months leading up to the study. Other than asthma or high cholesterol, patients in the study were free of health problems, researchers say.

Doctors checked in with patients in the study every three months. They asked about symptoms and medication use, and they tested lung function.

After one year, patients taking statins performed 35% worse in a test of lung function than they did at the start of the study. Patients who were not taking statins also saw their lung function decline, but it was about 14% worse compared to how they performed at the start of the study.

Patients on statins also reported that they had used their rescue medications [inhalers] 72% more often than they had at the start of the study. Those who weren't taking statins used rescue medications 9% more than they had before.

Patients on statins also reported getting up more frequently at night because of their asthma and said they had worse symptoms during the day.

Those findings are associations. The study wasn't able to prove that statins caused the increase in breathing problems.

An alternative explanation could be that people who were prescribed statins simply had more health problems, overall, than those who weren't taking the drugs, although researchers say they tried to balance the groups in the study to make sure that was not the case.

The findings echo a previous study that looked at the medical records of 759 asthma patients treated at the same clinic in Rochester, N.Y. In that study, 24 patients who were starting statins saw significant drops in lung function, needed more medication, had more nighttime asthma problems, and were seen in the office more frequently compared to 26 patients who were not taking those medications.

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Are Acid Reflux Drugs Overused?

Studies Suggest Many People Taking Them Don't Need Them and May Be Putting Their Health at Risk

Nov. 7, 2011 (Washington, D.C.) -- Many people who take popular antacid pills like Aciphex, Dexilant, Nexium, Prevacid, Prilosec, and Protonix don't need them, according to a series of studies presented here at the American College of Gastroenterology's annual meeting.

Doctors tend to overprescribe the drugs, known as proton pump inhibitors (PPIs), for patients in and out of the hospital, the studies find.

"I'm uncomfortable when people who have heartburn start the drugs on their own, or when a health care professional guesses and puts them on the drugs," says Mayo Clinic gastroenterologist Yvonne Romero, MD. Romero, who was not involved with the work, reviewed the findings for WebMD. She has received grants from makers of several acid-suppressing drugs.

Proton pump inhibitors are the most powerful class of antacid drugs. It's the third highest-selling class of drugs in the U.S. In 2009, doctors wrote 113.6 million prescriptions for the drugs. Prevacid 24HR, Prilosec OTC, and the combination medication Zegerid OTC that contains a PPI and sodium bicarbonate are available without prescription.

Why are they so popular? The drugs do a great job of reducing stomach acid. They are safe compared with most medications. But mostly, they make people feel better, Romero says.

They're not only more powerful than simple over-the-counter antacids such as Maalox, Rolaids, and Tums, they also reduce stomach acid more than the H2 receptor antagonist (H2RA) drugs such as Axid, Pepcid, Tagamet, and Zantac.

And many Americans find it's much easier to take a pill than to eat less chocolate, caffeine, fatty foods, or other foods that can trigger heartburn, she says.

On the doctor's side, electronic medical records may be contributing to misuse, Zachary Smith, MD, a medical resident at the University of Chicago's NorthShore University Health System in Evanston, Ill., tells WebMD.

For all their good, electronic records make it easy to continue a medication by pushing a button. "So once a patient is on a safe drug like a PPI, it may be continued indefinitely and into the outpatient setting," says Smith, who led one of the new studies.

What's the harm?

Plenty. "If you take them indiscriminately, you reduce the benefit-to-risk ratio," Romero says.

Published studies have linked PPIs to an increased risk of potentially deadly diarrhea caused by the bug Clostridium difficile, or C. diff. There's also a slightly increased risk of fracture in some risk women taking PPIs at high doses and/or for extended periods of time.

Several studies have shown that people who take a PPI may be more likely to catch pneumonia. Suppression of stomach acid may also reduce the body’s ability to absorb calcium and magnesium, Romero says.

And they’re not cheap, she adds. A year's supply of over-the-counter Prevacid 24HR costs about $200. If you're prescribed a more expensive PPI, the annual price tag could be 10 times higher or more.

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