Hiatal Hernia in Bronchial Asthma: The Importance of Concomitant Pulmonary Emphysema

Clémençon, Gérard H.; Österman, Per-Olof

doi:10.1159/000202637

Cited by 26 publications

(5 citation statements)

References 2 publications

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“…Although the screening questions for these disorders were simple (yes/no), the analysis of responses to follow-up questions was consistent and suggested protection against misclassification error. Because hyperinflation can predispose subjects to having GERD (25,26), we also substituted prealbuterol FVC % predicted in the multivariable model. This substitution did not diminish the association between GERD and EPA.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations

Denlinger

Phillips

Ramratnam

et al. 2017

Am J Respir Crit Care Med

382

267

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Rationale: Reducing asthma exacerbation frequency is an important criterion for approval of asthma therapies, but the clinical features of exacerbation-prone asthma (EPA) remain incompletely defined.Objectives: To describe the clinical, physiologic, inflammatory, and comorbidity factors associated with EPA.Methods: Baseline data from the NHLBI Severe Asthma Research Program (SARP)-3 were analyzed. An exacerbation was defined as a burst of systemic corticosteroids lasting 3 days or more. Patients were classified by their number of exacerbations in the past year: none, few (one to two), or exacerbation prone (>3). Replication of a multivariable model was performed with data from the SARP-1 1 2 cohort.Measurements and Main Results: Of 709 subjects in the SARP-3 cohort, 294 (41%) had no exacerbations and 173 (24%) were exacerbation prone in the prior year. Several factors normally associated with severity (asthma duration, age, sex, race, and socioeconomic status) did not associate with exacerbation frequency in SARP-3; bronchodilator responsiveness also discriminated exacerbation proneness from asthma severity. In the SARP-3 multivariable model, blood eosinophils, body mass index, and bronchodilator responsiveness were positively associated with exacerbation frequency (rate ratios [95% confidence interval],

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Section: Discussionmentioning

confidence: 99%

Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations

Denlinger

Phillips

Ramratnam

et al. 2017

Am J Respir Crit Care Med

382

267

View full text Add to dashboard Cite

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“…Patients with COPD may be at significantly greater risk of developing GERD [Garcia Rodríguez et al 2008], and the rate of COPD exacerbations is higher in patients with GERD symptoms [Terada et al 2008]. It is possible that emphysematous change and hyperinflation of the lung could enlarge total lung capacity, flatten the diaphragm, and increase the risk of sliding hernia of the esophagus [Clemencon and Osterman, 1961]. Although GERD does not appear to predispose patients to the development of COPD de novo, it is possible that GERD may worsen pre-existing COPD by, for example, increasing the frequency of exacerbations [Cholongitas et al 2008;Rascon-Aguilar et al 2006].…”

Section: ] Effects On Inflammatory Cellsmentioning

confidence: 99%

“…2008]. It is possible that emphysematous change and hyperinflation of the lung could enlarge total lung capacity, flatten the diaphragm, and increase the risk of sliding hernia of the esophagus [Clemencon and Osterman, 1961]. Although GERD does not appear to predispose patients to the development of COPD de novo , it is possible that GERD may worsen pre-existing COPD by, for example, increasing the frequency of exacerbations [Cholongitas et al .…”

Section: Mechanism Of Prevention Of Copd Exacerbations By Ppismentioning

confidence: 99%

A new strategy with proton pump inhibitors for the prevention of acute exacerbations in COPD

Sasaki

Nakayama

Yasuda

et al. 2011

Ther Adv Respir Dis

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Acute exacerbations of chronic obstructive pulmonary disease (COPD), an acute worsening of respiratory symptoms, generally result in a poor prognosis. Successful prevention and management of such exacerbations is thus important for patient care. Viral infection, primarily with rhinovirus (RV), is the foremost cause of exacerbations in COPD patients. Proton pump inhibitors (PPIs) have been reported to inhibit RV infection in human airway epithelial cells in vitro. Furthermore, clinical trials of PPIs in patients with COPD resulted in a reduction in rates of both common cold and COPD exacerbations. In this review, we discuss the significance of COPD exacerbations, summarize a published trial of the effect of low-dose PPIs on COPD exacerbations, and postulate a mechanism for this effect.

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“…The degree of hyperinflation may vary and during worsening asthma may become quite marked, with increases in the total lung capacity (TLC), residual volume (RV) and functional residual capacity (FRC). This results in a reduction in intrathoracic pressure, thus lowering the lower oesophageal sphincter (LOS) pressure and permitting GOR to occur more easily, an observation made over 30 yrs ago [27]. However, we know of no studies which have specifically related indices of GOR measured from intraoesophageal pH and pressure monitoring to the degree of hyperinflation per se.…”

Section: Mechanical Changes Due To Asthma As a Cause Of Gormentioning

confidence: 99%

Oesophageal reflux and asthma

Ayres

Miles²

1996

Eur Respir J

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Asthma and gastro-oesophageal reflux commonly occur together but the association in any individual may or may not be causal. Aspiration of gastric acid into the trachea has been demonstrated in some patients with asthma with concomitant falls in lung function, while acid in the lower oesophagus can exacerbate asthma by a vagal reflex following stimulation of lower oesophageal receptors. Conversely, asthma can lead to worsening reflux both through the use of smooth muscle relaxing anti-asthma medication and by the mechanical effects of hyperinflation reducing lower oesophageal sphincter pressures. The effects on asthma following treatment of reflux has been anecdotally reported to be successful in some individuals, particularly those with severe reflux, but surgery should be reserved for individuals only after failure of medical treatment and should be aimed at improving reflux symptoms rather than improving asthma control.

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Hiatal Hernia in Bronchial Asthma: The Importance of Concomitant Pulmonary Emphysema

Cited by 26 publications

References 2 publications

Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations

Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations

A new strategy with proton pump inhibitors for the prevention of acute exacerbations in COPD

Oesophageal reflux and asthma

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