Proton pump inhibitor (PPI) use in children appears to be associated with an increased risk of asthma, according to findings from a nationwide cohort study published in JAMA Pediatrics.

To investigate the association between PPI use among children and adolescents aged 0-17 years and the risk of asthma, study authors used a Swedish national registry to identify children who were initiated with a PPI (n=81,452) and those who had never received PPI (n=1,848,092) during the study period between January 2007 and June 2016. Patients were matched based on propensity score and age and were excluded if they were diagnosed with asthma or filled a prescription for an asthma medication within a certain time before the index date.

Before matching, children who were more likely to be initiated with a PPI were older, female, and had a higher prevalence of comorbidities. These patients also utilized more health care resources and were prescribed more medications such as antibiotics, systemic antihistamines, and systemic corticosteroids.

After propensity score matching, there were 80,870 children in each group. Findings showed that children who were initiated on PPIs were 57% more likely to be diagnosed with asthma than children who did not receive PPI therapy (HR 1.57; CI, 1.49-1.64). The incidence rate of asthma was reported to be 21.8 per 1000 person-years among PPI initiators and 14.0 per 1000 person-years among nonusers. The risk was observed to be highest in children younger than 2 years.

As for individual PPIs, the HRs reported were 1.64 for esomeprazole, 1.49 for lansoprazole, 1.43 for omeprazole, and 2.33 for pantoprazole. With regard to timing of asthma onset following PPI initiation, the HRs were 1.62, 1.73, and 1.53 for 0-90 days, 91-180 days, and 181 days to end of follow up, respectively.

“These findings suggest that asthma is one of several potential adverse events that should be considered when prescribing PPIs to children,” the authors concluded.

Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Wang Y, Wintzell V, Ludvigsson J, et al. Association between proton pump inhibitor use and risk of fracture in children. Published online February 8, 2021. JAMA Pediatr. doi: 10.1001/jamapediatrics.2020.0007.