MedWire News: Asymptomatic gastroesophageal reflux (GER) is not associated with reduced lung function or respiratory symptoms in patients with poorly controlled asthma, researchers have found.
“GER is common in patients with asthma, particularly in those with difficult-to-control asthma, with a reported prevalence of 32% to 84%, [and] often occurs in the absence of symptoms such as heartburn,” explain Emily DiMango (Columbia University Medical Center, New York, USA) and team.
To determine whether GER in asthma patients relates to symptom severity and/or lung function impairment, the team studied data on 304 adult patients who had poorly-controlled asthma despite the use of moderate or higher doses of inhaled corticosteroids. None of the participants had undergone antireflux or peptic ulcer surgery, or had any clinical indications for acid suppression treatment (ie, two or more heartburn episodes per week requiring antacids).
All the participants underwent 24-hour esophageal pH probe monitoring to test for proximal and/or distal GER. Their lung function, asthma symptoms, response to methacholine challenge, and quality of life scores were also assessed.
Results of pH monitoring revealed that 53% of patients had GER, and of the 242 with recordings of proximal pH, 38% had proximal GER.
Analysis revealed no significant differences between patients with and without proximal or distal GER regarding lung function, the need for short-acting bronchodilators, nocturnal awakenings, doses of inhaled corticosteroids, the use of long-acting β-agonists, and methacholine reactivity.
However, participants with GER, particularly those with proximal GER, used more oral corticosteroids and had worse asthma- and health-related quality of life than those without GER.
DiMango and team conclude: “These results indicate that although asymptomatic GER frequently accompanies poorly controlled asthma, it is not associated with lower lung function, worse asthma control, or increased airway responsiveness, but is associated with significantly worse asthma quality of life.”
They add: “Evaluation for GER using ambulatory pH probes in individuals with poorly controlled asthma with no reflux symptoms is therefore not usually warranted unless atypical symptoms, such as cough or unexplained chest symptoms, might suggest the diagnosis.”
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