geoffrey modest medical blogs

  A recent Belgian study found that the use of proton pump inhibitors (PPIs) is associated with increased exacerbations of COPD and asthma (which they refer to as chronic obstructive airway diseases, COADs) in a dose-response way: see copd inc with PPIs Chest2026 in dropbox, or DOI: https://doi.org/10.1016/j.chest.2026.01.002   Details : -- 932,135 patients (with a total of 1,084,446 person-years of follow-up) were identified using the Belgian nationwide claims-based data of adult patients receiving long-term medication for COADs (ie, having at least two dispensings of medication for obstructive lung diseases) between 2017 and 2022 -- patients on histamine type 2 receptor antagonists (H2RAs) were excluded (at that time there was a carcinogen impurity found in ranitidine, the most prescribed H2 blocker, that was taken off the market), -- 416,087 patients (44.6%) were also receiving PPIs: -- mean age 61, 54% female, 29% low socioeconomic status (assessed by their medical cover...

      given my general feelings that gabapentinoids (gabapentin and pregabalin) are dramatically over-prescribed and often for inappropriate indications, this blog will address issues of major complications in terms of asthma and COPD as well as heart failure associated with their use (see gabapentinoids inc asthma Thorax2025  in dropbox, or https:// doi. org/ 10. 1136/ thorax- 2025- 223240).  Details : -- researchers in Japan accessed their National Database of Health Insurance Claims and Specific Health Check-ups (NDB) from 2015 to 2023     -- this database has data from all public insurers in Japan, resulting in nearly complete coverage of hospitals nationwide, with demographic data on each patient as well as diagnoses, examinations, and treatments from both inpatient and outpatient settings -- the patients included were at least 40 years old (that is when routine checkups are done in ...

  a recent systematic review and meta-analysis compared short-acting β agonists (SABA) alone with SABA combined with inhaled corticosteroids (ICS), and with the fast-onset, long-acting β agonist (LABA) formoterol combined with ICS for asthma, finding that a SABA alone was the least effective (see   asthma best reliever rx JAMA2024  in dropbox, or doi:10.1001/jama.2024.22700) Details : -- 27 randomized clinical trials with 50,496 adult and pediatric patients treated in outpatient settings were included in this network meta-analysis, with 2 studies done just in pediatric patients aged <19yo  -- here are the comparisons in this network meta-analysis; the size of the lines and circles represent the numbers of RCTs and patients in the comparisons (82% of these comparisons were considered to have a low overall risk of bias): -- mean age 41.0 years; 20,288 male (40%) -- formoterol was the long-acting β agonist (LABA, alone or combined with an ICS, inhaled corticoste...