Changes in pulmonary hyperinflation and bronchial hyperresponsiveness following treatment with lansoprazole in children with cystic fibrosis

In this prospective open study of 14 children with cystic fibrosis (CF), we evaluated the effect of 1 year adjuvant therapy with lansoprazole, a proto n pump inhibitor (PPI), on growth, fecal fat loss, body composition and lun g function. Only stable patients with pancreatic insufficiency were include d, and their data were compared to those of a large Dutch pediatric normal reference population. During the use of the PPI, mean weight and height did not change significan tly, while body mass index improved (P < 0.05). An immediate significant an d persistent reduction of fecal acid steatocrit (P < 0.05) was demonstrated . Compared to normal Dutch children, the CF patients showed significantly d ecreased standard deviation scores (SDS) for total body fat (TBF, -0.966) a nd fat-free mass (FFM, -1.826). Under lansoprazole, TBF improved significan tly (P < 0.05, while mean FFM remained unchanged. A significant improvement in total lung capacity (P < 0.05), residual volume (P = 0.055), and maxima l inspiratory mouth pressure (P = 0.002) was also demonstrated. Hyperinflat ion tended to decrease during the use of a PPI. Daily recordings of peak ex piratory flow (PEF) showed a maximal diurnal variability of 28% of recent b est PEF and minimal morning PEF of 72% of recent best PEF, confirming that bronchial hyperresponsiveness is increased in CF. We conclude that adjuvant therapy with lansoprazole in young CF patients wi th persistent fat malabsorption, decreased fat losses and improved total bo dy fat. Lung hyperinflation decreased, which may partly explain the improve ment in inspiratory muscle performance. The simultaneous improvements in bo dy composition and lung hyperinflation suggest a relationship between these two parameters. Further research is necessary to confirm such a relationsh ip and to elucidate the mechanisms involved. (C) 2001 Wiley-Liss. Inc.