Prevalence of Gastroesophageal Reflux Symptoms in Asthma

doi:10.1378/chest.109.2.316

Chest

Volume 109, Issue 2, February 1996, Pages 316-322

https://doi.org/10.1378/chest.109.2.316 Get rights and content

Study objective

To determine the prevalences of symptomatic gastroesophageal reflux (GER), reflux-associated respiratory symptoms (RARS), and reflux-associated β-agonist inhaler use in asthmatics.

Design

Questionnaire-based, cross-sectional analytic survey.

Setting

Outpatient asthma and clinical research clinics attached to the University of Calgary tertiary care centre and two family practices.

Patients

Asthma group consisted of 109 patients referred to an outpatient asthma clinic. First control group consisted of 68 patients visiting their family physicians. Second control group consisted of 67 patients with thyroid disease, hypercholesterolemia, or diabetes participating in drug trials.

Results

Among the asthmatics, 77%, 55%, and 24% experienced heartburn, regurgitation, and swallowing difficulties, respectively. Symptoms were less prevalent in the control groups. At least one antireflux medication was required by 37% of asthmatics (p<0.00l, vs controls). None of the asthma medications were associated with an increased likelihood of symptomatic GER. In the week prior to completing the questionnaire, 41% of the asthmatics noted RARS, including cough, dyspnea, and wheeze and 28% used their inhalers while experiencing GER symptoms. Inhaler use correlated with the severity of heartburn (r=0.28, p<0.05) and regurgitation (r=0.40, p<0.05)

Conclusions

The questionnaire demonstrated a greater prevalence of GER symptoms, RARS, and reflux-associated inhaler use in asthmatics. This excessive inhaler use may explain how GER indirectly causes asthma to worsen.

Section snippets

Patient Selection

Asthma Patients: Consecutive patients, both newly referred and follow-up, attending the Calgary Asthma Clinic over a 10-week period were surveyed. All patients who fulfilled the following criteria for the definition of asthma were included in the study. Patients had at least one of the following: an increase in FEV₁ of at least 15% after bronchodilator, spontaneous variability of peak expiratory flow rates (PEFR) or FEV₁ of 20% or more, or a positive histamine challenge test and a clinical

RESULTS

One hundred nine of 163 consecutive patients seen in the asthma clinic satisfied the criteria for the diagnosis of asthma (see Materials and Methods section) and comprise the asthma group. Their clinical data and those of the two control groups are presented in Table 2. The mean age, BMI, and gender ratios of the asthma group were similar to those of the control groups. Among the subjects in each group, the mean age, BMI, and gender proportions were similar in the subjects with and without

DISCUSSION

The most important findings of this study are that symptomatic GER is common and that it is associated with respiratory symptoms and β-agonist inhaler use in asthmatics. The questionnaire determined a greater prevalence of reflux symptoms in asthmatics than in two control groups of similar age, gender ratio, BMI, alcohol habits, and tobacco habits.

A recent ambulatory pH monitoring study done in an American Veteran's Administration hospital demonstrated abnormal GER in more than 80% of

ACKNOWLEDGMENTS

The authors wish to thank their colleagues in the University of Calgary Respiratory Division, Drs. D. Coe and N. Wong, for allowing us to study their patients, and nursing and support staff in the asthma clinic (D. Wiebe, C. Hegi, S. Revitt, L. Robertshaw, B. Gawley, E. Berrell, J. Evans) and Alberta. Respiratory Services staff (D. Popil, H. Pischke). We are grateful for Lyndsey Guyn's help with computerization and analysis of the data.

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There are limited studies on healthcare resource use (HCRU) among adult asthma patients in Japan using real-world evidence, and analysis on acute treatment and associated costs stratified by disease severity is further limited. This study aimed to characterize the disease burden of severe asthma patients in Japan in terms of HCRU and comorbid medical conditions, with particular interest in oral corticosteroid (OCS) dependency.
This retrospective cohort study of asthma patients used data from a claims database of diagnosis procedure combination hospitals in Japan. The severe asthma cohort included patients treated with OCS for more than 180 days in one year before the index date, with at least one asthma diagnosis claim. Comorbidity and drug use in the look-back period, HCRU, assumed OCS-related adverse events, and asthma exacerbations in the follow-up period were analyzed.
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In this study, multivariate analysis confirmed that GERLS was significantly and independently associated with hyposalivation. GERD is one of the most common comorbidities in patients with asthma, with an estimated prevalence of 40%–80% [22,23]. GERD is also an important comorbidity of asthma and is associated with the pathophysiology of severe asthma.
Previous studies have suggested a significant relationship between hyposalivation and inhalation therapy-induced oropharyngeal problems. However, salivary secretion tests are not widely performed in daily clinical practice. In fact, xerostomia, the complaint of dry mouth, may not indicate hyposalivation. Therefore, we determined the clinical factors associated with hyposalivation in patients with asthma.
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Age, xerostomia, and GERLS were significantly related to hyposalivation in patients with asthma. To identify oropharyngeal problems in these patients, a careful assessment of the suspected symptoms of gastroesophageal reflux may be useful.
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View all citing articles on Scopus

Presented in abstract form at the Annual Meeting of the American Thoracic Society, Boston, May 22–25, 1994.

accepted September 19.

^†: Salary support in part by the Alberta Lung Association and Fisons Pharmaceuticals (Ms. Underwood).

View full text

Chest

Clinical Investigations: AsthmaPrevalence of Gastroesophageal Reflux Symptoms in Asthma

Study objective

Design

Setting

Patients

Results

Conclusions

Section snippets

Patient Selection

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

Dis Chest

Dis Chest

J Thorac Cardiovasc Surg

Am J Med

J Allergy Clin Immunol

Gastroenterology

Gastroenterology

J Allergy Clin Immunol

Chest

Gastroenterology

Lancet

Lancet

Intrinsic asthma in adults: association with gastroesophageal reflux

JAMA

Gastroesophageal reflux and asthma: a possible reflex mechanism

Ann Allergy

Respiratory complications of gastroesophageal reflux

Arch Intern Med

Gastroesophageal reflux pathogenesis, diagnosis and therapy

Ann Intern Med

Most asthmatics have reflux with or without bronchodilator therapy

Gastroenterology

Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study

Thorax

Clinical Investigations: Asthma
Prevalence of Gastroesophageal Reflux Symptoms in Asthma