Abstract
Background:
Epidemiological studies have repeatedly shown an association between asthma and gastro-oesophageal reflux disease (GORD) .
There is an observed link between oral corticosteroid (OCS) use and increased oesophageal acid contact time thus precipitating GORD symptoms . Our aim was to confirm this link in patients with severe allergic asthma (SAR)
Methods:
A retrospective study was performed on 30 patients with SAR on Omalizumab (OMB)
Data was obtained from hospital & , GP records on OCS use, hospital resource use, and Asthma control questionnaires (ACT and AQLQ) to assess severity of asthma. The RDQ (reflux disease questionnaire) was used to assess GORD symptoms and severity. All variables were assessed 1 year pre and post-OMB therapy.
Results:
Patients were receiving OMB for an average of 36.5 months 80% (24/30) had an element of reflux disease (RDQ score >12); Reflux symptoms were severe in 50% & mild/moderate in 50% of patients. 16/24 patients had previously undiagnosed GORD symptoms had no active treatment.
OCS dose/yr pre-omalizumab in patients with moderate-severe GORD was 3.04gm [±1.55]. This compares with the OCS dose in no GORD symptoms of 2.18 [±2.03].
Pre and post-OMB OCS in g/yr were compared. Patients with 'much better' GORD symptoms showed [SD] 98.3% [±3.4] reduction in OCS therapy. Similarly, 'a little improvement' showed [SD] 97.8% [±7.7] reduction. 'No change' showed a smaller decrease in OCS of [SD] 59.4% [±19].
Conclusion
Severe allergic asthma is often associated with GORD symptoms. Our study shows a clear link between higher corticosteroid use and GORD irrespective of the severity of asthma.Reduction in OCS usage led to better GORD scores.
- © 2014 ERS