Chest
Volume 114, Issue 1, July 1998, Pages 275-283
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Special Report
Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux?: A Critical Review of the Literature

https://doi.org/10.1378/chest.114.1.275Get rights and content

Objective

Identify and critically review the peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthmatics with gastroesophageal reflux (GER).

Design

Using the 1966 to 1996 MEDLINE database, asthma was combined with GER to identify all studies of the effects of medical antireflux therapy on asthma control. The articles' bibliographies were also reviewed. Studies were graded according to Sackett's criteria and grouped by levels of evidence.

Results

A total of 242 citations were found; 171 were published in English. Twelve studies of the effects of medical antireflux therapy on asthma control, with a total of 326 treated patients, were identified. Eight studies were placebo-controlled, three were open studies, and one used an untreated control. Eight studies treated 20 or fewer patients. Reflux symptoms either did not improve or the effects of antireflux therapy on them were not reported in four studies. The combined data from the controlled medical antireflux studies showed that: (1) asthma symptoms improved in 69% of the subjects; (2) asthma medication use was reduced in 62% of the subjects; (3) evening peak expiratory flow (PEF), but not PEF at other times, improved in 26% of the subjects; and (4) spirometry did not improve in any of the placebo-controlled antireflux studies.

Conclusions

Analysis of the combined data suggests that medical antireflux therapy improves asthma symptoms, may reduce asthma medication use, but has minimal or no effect on lung function.

Section snippets

Materials and Methods

The MEDLINE database was used to identify studies published from 1966 to 1996 on the effects of medical antireflux therapy in asthma. The term asthma was combined with gastroesophageal reflux. Using the MEDLINE database, asthma was also combined with antacids, alginates, cimetidine, ranitidine, famotidine, nizatidine, cisapride, omeprazole, lansoprazole, pantoprazole, domperidone, and metoclopramide to insure that we identified all published English-language reports of medical antireflux

Results

A total of 242 papers were identified, 171 of which were published in English. Among these were 38 reviews, 15 editorials, and 20 letters. One letter reporting exacerbation of brittle asthma with cisapride32 and one report of a patient whose asthma improved with omeprazole after treatment with a combination of ranitidine and domperidone failed33 were not included in the analysis.

Surprisingly, only 12 studies of antireflux medication in asthmatics with GER have been published in the

Discussion

Is there a consensus among the antireflux studies?

Given the attention to the relationship between GER and asthma, it is surprising that there have been only 12 published, peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthma. Comparison of the different studies is difficult because their designs have been so different. Because these studies were done over a 15-year period, the asthma medications used, doses and duration of therapy, and both the

Conclusions

Despite the considerable literature dedicated to asthma and GER throughout the past 35 years, the nature of the relationship remains controversial. Clearly, there is a strong association between the two conditions. Regular symptomatic GER is four to five times more common in patients with asthma than in other patient groups.2 Abnormal GER, hiatal hernia, and esophagitis are also prevalent in asthma patients.3,4 Moreover, many asthmatics experience RARS and use their β-agonist inhalers during

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