Your Heartburn Medication Might Be Triggering Lung Flare-Ups—Here's What Doctors Found

If you take proton pump inhibitors (PPIs)—common heartburn medications—and have asthma or chronic obstructive pulmonary disease (COPD), new research suggests you may face a higher risk of respiratory flare-ups. A large study published in Chest found that cumulative PPI use was associated with increased exacerbation risk in patients with obstructive lung diseases, with the risk climbing as doses increased over time.

What Did Researchers Discover About PPIs and Lung Disease?

Researchers from Belgium analyzed pharmacy records for over 932,000 patients with obstructive lung diseases between 2017 and 2021. The study tracked patients taking at least two medications for asthma or COPD to see how PPI use affected their respiratory health. The findings were striking: patients not using PPIs experienced moderate to severe exacerbations at a rate of 49.3 per 100 person-years, while those using PPIs had rates of 77.7 per 100 person-years—a significant difference.

The dose-response pattern was particularly concerning. As cumulative PPI exposure increased, so did exacerbation risk. Compared to patients who didn't use PPIs, those taking the highest doses (more than 365 defined daily doses per year) had a 25% increased risk of exacerbations. Even lower doses showed elevated risk: patients taking up to 28 defined daily doses had a 9% increased risk, while those taking 29 to 180 doses had a 15% increased risk.

Who Faces the Greatest Risk?

The study revealed that certain groups experienced stronger associations between PPI use and lung flare-ups. The most pronounced effects occurred in younger patients, those without a diagnosis of gastroesophageal reflux disease (GERD), non-frail patients, and people with asthma or asthma-COPD overlap. This finding surprised researchers because it suggested that PPIs may be particularly risky for patients taking them without a clear medical reason—such as those without GERD who might be using them preventatively.

The study also found stronger associations in asthma patients compared to those with COPD alone, suggesting that asthma may be more sensitive to the effects of long-term PPI use.

How to Discuss PPI Use With Your Doctor

• Review Your Indication: Ask your doctor whether you still need your PPI and whether your original reason for taking it (such as GERD or ulcers) is still present. Many patients continue PPIs without an ongoing clear medical need.
• Discuss Alternatives: If you have asthma or COPD, talk about whether lower-dose options, shorter-term use, or alternative heartburn treatments might work for you instead of long-term PPI therapy.
• Monitor Your Symptoms: Keep track of any changes in your respiratory symptoms, including increased coughing, shortness of breath, or more frequent flare-ups, and report these to your healthcare provider.
• Schedule Regular Check-Ins: If you must continue PPI therapy, establish regular appointments with your doctor to reassess whether the medication remains necessary and to monitor your lung health.

"We found an increased exacerbation risk in patients using PPIs, particularly among chronic users. Associations were most pronounced in younger patients, in those without GERD, in non-frail patients, and in patients with asthma," the researchers stated. They emphasized that these findings "highlight the need to carefully (re)consider their use in clinical practice, particularly in patients without an ongoing clear indication."

Why Might PPIs Affect Your Lungs?

While the study documents the association between PPI use and increased exacerbations, the exact mechanism isn't fully understood. PPIs work by reducing stomach acid, which can alter the balance of bacteria in your digestive system and potentially affect immune function. Some researchers theorize that changes in gut bacteria may influence respiratory health, though more research is needed to confirm this connection.

It's important to note that the study was observational, meaning it shows a correlation rather than proving that PPIs directly cause exacerbations. However, the dose-response pattern—where higher doses showed progressively greater risk—strengthens the evidence that the relationship is meaningful rather than coincidental.

What Should You Do If You Take PPIs?

If you have asthma or COPD and take a PPI regularly, don't stop the medication on your own. Instead, schedule an appointment with your doctor to discuss whether you still need it. Your doctor can help you weigh the benefits of heartburn control against the potential respiratory risks. For some patients, the PPI may be essential; for others, deprescribing or switching to a different approach might be safer.

This research adds to a growing body of evidence suggesting that common medications deserve regular reassessment, especially in patients with chronic respiratory conditions. The key takeaway is that "one-size-fits-all" medication use—continuing a drug simply because you've always taken it—may not be in your best interest, particularly when respiratory health is at stake.