Relationship between asthma and gastro-oesophageal reflux.

Abstract

Twenty patients with bronchial asthma who also had gastro-oesophageal reflux were investigated. The severity of their reflux was graded using symptom score of heartburn and regurgitation and by the following investigations: barium swallow and meal, fibreoptic endoscopy and biopsy, manometry and pH monitoring of the distal oesophagus, and an acid infusion test. Full lung function studies were performed and patients were entered into a double-blind crossover study using cimetidine to control their reflux in order to assess beneficial effects with respect to their respiratory problems. Eighteen patients completed the study. Significant improvements were seen in reflux and night time asthmatic symptoms, both these indices being measured on a scoring system. Home monitoring of peak flow values showed a statistical improvement for the last peak flow reading of the day. Fourteen patients felt that their chest symptoms had significantly improved during the cimetidine period.Gastro-oesophageal reflux commonly produces symptoms in subjects of all ages. The dominant complaints are usually related to the upper gastrointestinal tract and include heartburn, regurgitation, and occasionally dysphagia. Patients with re'lux are also liable to respiratory complications leading to severe, progressive, and disabling pulmonary damage.' More recently attention has been drawn to an association between reflux and exacerbations of bronchial asthma,23 and there have been several studies suggesting subjective improvement in such patients after surgical correction of hiatus hernia. [3][4][5] In this study we have attempted to demonstrate a measurable improvement in symptoms and respiratory function in a group of asthmatic patients, who also had well-documented reflux, by controlling their reflux with cimetidine in a double-blind, crossover trial. MethodsInformed consent for study was obtained from 20 patients, 13 men and seven women, whose ages ranged from 30-65 years (mean 54 years). All patients had bronchial asthma and were attending

Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux.

“…Representative data from a control subject and the asthmatic patients are shown in figs 2 Time (hours) Figure 3 Data from four patients complaining of nocturnal asthma presented as in fig. 2.…”

A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease

“…There have been many studies dealing with asthma outcome and medical anti-reflux therapy. Field and Sutherland (1998) reviewed the previously published data on medical anti-reflux therapy with H 2 -receptor blockers (H 2 blockers), cimetidine (Goodall et al 1981;Larrain et al 1991) and ranitidine (Harper et al 1987;Nagel et al 1988;Ekstrom et al 1989;Gustaffson et al 1992), and with a proton pump inhibitor (PPI) omeprazole (Ford et al 1994;Meier et al 1994;Harding et al 1996;Teichtahl et al 1996), showing that asthma symptoms were improved. Kiljander (2003) suggested that, in the management of GERD-related asthma, PPIs other than omeprazole should be used at double the standard dose.…”

Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained?

“…Field et al (13) found that 41% experienced RARS and 28% used their rescue beta agonist during episodes of symptomatic GER. Goodall et al (33) reported a correlation between the severity of GER and asthma symptoms. Harding et al (34) reported a temporal correlation between GER, documented by ambulatory pH monitoring, and respiratory symptoms in asthma patients.…”

“…A recent critical review identified 12 English-language studies of the effects of medical antireflux therapy in people with asthma with GER (76). In the eight controlled studies, two used cimetidine, four ranitidine and two omeprazole (10,32,33,(67)(68)(69)77,78). A critical review of the controlled studies indicates that medical antireflux therapy improved GER symptoms, asthma symptoms and asthma medication requirements (76).…”

“…THERAPY IN ASTHMA Reports of asthma improving with successful antireflux surgery led investigators to study the effects of H2 receptor blockers in patients with asthma with GER (32,33,56,(67)(68)(69). Initially, there were concerns that these medications may cause clinical worsening of asthma because of H2 receptor blockade in the bronchial tree (70)(71)(72).…”