Long-term use of acid reflux drugs may raise the risk of severe respiratory complications and emergency care visits for asthma patients treated with biologics.
RT’s Three Key Takeaways:
- Increased Flare-Up Risk: Patients with difficult-to-treat asthma receiving biologic therapies experienced significantly higher rates of asthma exacerbations, emergency visits, and intensive care unit admissions when chronically taking proton pump inhibitors.
- Elevated Infection and Steroid Rates: Long-term acid suppression was associated with nearly fourfold increases in both rescue systemic corticosteroid use and respiratory infections among matched patient cohorts.
- Need for Deprescribing: Clinicians are urged to reevaluate ongoing acid suppression regimens and establish structured deprescribing plans for patients who lack clear ulcer-related indications.
Chronic proton pump inhibitor (PPI) use was associated with increased asthma exacerbations, systemic corticosteroid use, respiratory infections, and healthcare utilization among patients with difficult-to-treat asthma receiving biologic therapy, according to study findings presented at Chest 2026.
Researchers conducted a retrospective propensity score-matched cohort study using the TriNetX US Collaborative Network, which includes 65 healthcare organizations. The investigation evaluated adults with asthma who were treated with biologic agents between 2014 and 2025, according to the researchers. To isolate empiric PPI use, investigators excluded individuals with established ulcer-related indications, comparing PPI users with nonusers from one to 365 days following the index prescription, the news release stated.
Heightened Morbidity and Healthcare Utilization
Historically, PPIs have shown modest benefit in a small subset of individuals with asthma, specifically those presenting with nocturnal symptoms and coexisting reflux, according to the study authors. However, during the one-year follow-up period, chronic PPI therapy was associated with significantly higher rates of asthma exacerbations (31.9% vs 22.6%; OR, 1.60), rescue systemic corticosteroid use (72% vs 40%; OR, 3.88), and respiratory infections (8.4% vs 2.3%; OR, 3.83), the researchers reported.
Healthcare facility utilization was also elevated among chronic users. The analysis revealed higher rates of emergency visits (15.6% vs 8.4%; OR, 2.00) and ICU admissions (4.3% vs 1.2%; OR, 3.65) among patients taking PPIs, according to the findings. All-cause mortality did not differ significantly between the cohorts, the study authors noted.
Reassessing Long-Term Acid Suppression
“Clinicians should carefully reassess the necessity of chronic PPI therapy in biologictreated asthma patients without clear ulcer-related indications,” said Joshua Le, MD, a Chest 2026 presenting author. “Chronic PPI use frequently persists as an act of omission, with therapy continued beyond its initial short-term indication despite resolution of symptoms or lack of objective need. Proactive medication reconciliation, clear documentation of indication, and structured deprescribing strategies may reduce unnecessary long-term exposure and help mitigate preventable morbidity in this vulnerable population.”
The researchers suggested that long-term acid suppression could represent a modifiable risk factor, noting that the adverse associations might be mediated by alterations to the microbiome and increased susceptibility to respiratory pathogens.
