The relationship between gastroesophageal reflux and asthma: an update

McCallister, Jennifer W.; Parsons, Jonathan P.; Mastronarde, John G.

doi:10.1177/1753465810384606

Cited by 47 publications

(37 citation statements)

References 43 publications

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“…In the absence of a response to saline irrigation with or without topical corticosteroids and/or anti-histamines, a computerized tomography (CT) scan of the sinuses and a referral to a dedicated Ear, Nose and Throat physician should be considered. GERD occurs in nearly 80% of all individuals with asthma 16 but despite this high prevalence, empiric treatment of all asthma patients with a proton pump inhibitor has not proven to be effective in decreasing asthma exacerbations. 16 If nocturnal cough remains a predominant asthma symptom despite the absence of overt reflux, a 24 hour esophageal pH monitoring may identify previously unrecognized GERD.…”

Section: Summary Of Evidence and Key Messagesmentioning

confidence: 99%

“…GERD occurs in nearly 80% of all individuals with asthma 16 but despite this high prevalence, empiric treatment of all asthma patients with a proton pump inhibitor has not proven to be effective in decreasing asthma exacerbations. 16 If nocturnal cough remains a predominant asthma symptom despite the absence of overt reflux, a 24 hour esophageal pH monitoring may identify previously unrecognized GERD. Upper gastrointestinal endoscopy should be considered in individuals with eosinophilia and suspected of having eosinophilic esophagitis.…”

Section: Summary Of Evidence and Key Messagesmentioning

confidence: 99%

See 1 more Smart Citation

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: While severe asthma affects approximately 5% of all individuals with asthma, this small minority of individuals accounts for a large proportion of the asthma-related costs. Greater understanding of the pathophysiology of asthma combined with the emergence of novel biologic therapies for severe asthma supported the need for a thorough review of the diagnosis, investigation, phenotyping, and management of severe asthma. OBJECTIVES: We aimed to propose a practical approach to distinguish uncontrolled asthma due to inadequate asthma management from severe asthma despite optimal asthma management. Moreover, based on emerging scientific evidence, we sought to provide guidance for characterizing individuals with severe asthma and considering a phenotype-specific management. We also aimed to review other novel new potential therapeutic approaches. METHODS: We systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert opinion, were agreed upon by unanimous consensus. MAIN RESULTS: We defined severe asthma and outlined its significant impact from the societal and patient perspectives. We outlined a practical approach to distinguish severe from uncontrolled but not severe asthma, based on stepwise investigation and management of potential reasons for uncontrolled asthma. After reviewing the current evidence we concluded that: 1) Several biomarkers (e.g. sputum or blood eosinophil count, total IgE, or FeNO) can help identify potential responders to new therapeutic options; 2) Tiotropium may be considered as an add-on therapy for individuals 12 years of age and over with severe asthma uncontrolled despite combination ICS/LABA therapy; 3) The chronic use of macrolides may decrease asthma exacerbations in individuals 18 years of age and over with severe asthma independent of their inflammatory profile; 4) Children aged 6 years and older and adults who are sensitized to at least one relevant perennial allergen and who remain poorly controlled asthmatics despite high dose ICS and a second controller can benefit from the addition of anti-IgE therapy to reduce asthma exacerbations; due to the known risk of side effects associated with high-dose ICS in children, omalizumab should also be considered in children and adolescents who repeatedly exacerbate or have poor control when therapy is stepped down from high-dose to moderate-dose ICS and at least one other controller; 5) Anti-IL5 therapies may be considered for adults 18 years of age and over with severe eosinophilic asthma who experience recurrent asthma exacerbations in spite of high doses of ICS in addition to at least one other controller; and 6) Although bronchial thermoplasty has shown a decrease in asthma exacerbations in one study, its role in the treatment of severe asthma remains uncertain. CONCLUSIONS: After reviewing existing and emerging therapies for severe asthma, we developed ke...

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Section: Summary Of Evidence and Key Messagesmentioning

confidence: 99%

Section: Summary Of Evidence and Key Messagesmentioning

confidence: 99%

Recognition and management of severe asthma: A Canadian Thoracic Society position statement

FitzGerald

Lemière

Lougheed

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

View full text Add to dashboard Cite

show abstract

“…Gastroesophageal reflux disease could worsen asthma either by direct effects on airway responsiveness or via aspiration-induced inflammation [84]. Conversely, the bronchoconstriction observed in…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

“…However, inconsistent results have been obtained in several studies on the effects of treatment of GERD on asthma outcomes [84,85]. In 2003, a Cochrane systematic review of the available literature examining the effect of GERD treatment for asthma showed that antireflux therapy did not consistently improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications [86].…”

Section: Reviewmentioning

confidence: 99%

Asthma-related comorbidities

Boulet¹,

Boulay²

2011

Expert Review of Respiratory Medicine

226

147

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“…The authors write that current available data has shown limited benefit of treatment in symptomatic gastroesophageal reflux disease (GERD) with asthma and no clear benefit of asthma control. Reviewed data suggests empirical treatment of asymptomatic GERD in asthmatics is not a useful practice; instead, the clinician should focus on other factors which can affect asthma control [McCallister et al 2011]. …”

mentioning

confidence: 99%