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Effects of Asymptomatic Proximal and Distal Gastroesophageal Reflux on Asthma Severity

¹ Columbia University, College of Physicians and Surgeons, New York, New York; ² Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; ³ New York University School of Medicine, New York, New York; ⁴ Temple University School of Medicine, Philadelphia, Pennsylvania; ⁵ The Ohio State University Medical College, Columbus, Ohio; and ⁶ Johns Hopkins University School of Medicine, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Emily DiMango, M.D., Columbia University Medical Center, 622 West 168th Street, PH 8 Center, New York, NY 10032. E-mail: ead3{at}columbia.edu

Rationale: Silent gastroesophageal reflux (GER) is common in patients with asthma, but it is unclear whether GER is associated with worse asthma symptoms or reduced lung function.

Objectives: To determine in patients with poorly controlled asthma, whether proximal or distal esophageal reflux is associated with asthma severity, symptoms, physiology, or functional status.

Methods: Baseline asthma characteristics were measured in patients with asthma enrolled in a multicenter trial assessing the effectiveness of esomeprazole on asthma control. All participants underwent 24-hour esophageal pH probe monitoring. Lung function, methacholine responsiveness, asthma symptoms, and quality-of-life scores were compared in subjects with and without GER.

Measurements and Main Results: Of 304 participants with probe recordings, 53% had reflux. Of 242 participants with recordings of proximal pH, 38% had proximal reflux. There was no difference in need for short-acting bronchodilators, nocturnal awakenings, dose of inhaled corticosteroid, use of long-acting β-agonists, lung function, or methacholine reactivity between individuals with and without proximal or distal GER. Participants with GER reported more use of oral corticosteroids and had worse asthma quality of life and subjects with proximal GER had significantly worse asthma quality of life and health-related quality of life compared with participants without GER.

Conclusions: Asymptomatic GER is not associated with distinguishing asthma symptoms or lower lung function in individuals with suboptimal asthma control who are using inhaled corticosteroids. Patients with proximal reflux report significantly worse asthma and health-related quality of life despite lack of physiologic impairment or increase in asthma symptoms.

Clinical trial registered with www.clinicaltrials.gov (NCT00069823).

Key Words: lung function • nocturnal symptoms • asthma • gastroesophageal reflux

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Gastroesophageal reflux has been considered a possible trigger for poor asthma control. Studies of the effect of acid suppressor therapy have shown conflicting effects on asthma control. What This Study Adds to the Field We demonstrate that asymptomatic GER is not associated with distinguishing demographic or clinical features in patients with asthma and suboptimal control despite treatment with inhaled corticosteroids, but is associated with poorer health-related quality of life.

 

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