Role of gastroesophageal reflux in older children with persistent asthma

Chest. 2003 Apr;123(4):1008-13. doi: 10.1378/chest.123.4.1008.

Abstract

Background: Gastroesophageal reflux (GER) plays a role in inducing or exacerbating asthma.

Methods: We evaluated asthma outcome before and after anti-GER treatment in older children (age range, 5 to 10.5 years) who had persistent moderate asthma and were being treated with short- and long-acting bronchodilators, inhaled corticosteroids, and leukotriene antagonists. Forty-six such consecutive children underwent extended esophageal pH monitoring. Of the 27 patients (59%) who had evidence of GER disease, 18 patients underwent medical treatment (lifestyle changes, proton pump inhibitors, and prokinetics) and 9 patients opted for surgical treatment (Nissen fundoplication) of GER. Of the 19 patients with normal pH study findings, 8 patients underwent empiric medical anti-GER treatment and the remaining 11 patients served as a control group. Data on all patients were collected from 6 months prior to performing the pH studies and for 12 months after initiation of anti-GER treatment. The frequency of oral and inhaled corticosteroids, short- and long-acting bronchodilators, and leukotriene antagonists was prospectively recorded.

Results: There was a significant reduction in the use of short- and long-acting bronchodilators as well as inhaled corticosteroids after anti-GER treatment was instituted in patients with GER disease (p < 0.05). Two patients (25%) without evidence of GER disease showed significant reduction in need for asthma medication after anti-GER treatment, but none of the patients without GER disease and no GER treatment showed any significant reduction in the need for asthma medications.

Conclusions: Anti-GER treatment in patients with GER disease and asthma results in a significant reduction in the requirement of asthma medications.

MeSH terms

  • Anti-Asthmatic Agents / administration & dosage
  • Asthma / complications*
  • Asthma / drug therapy
  • Bronchodilator Agents / therapeutic use
  • Child
  • Female
  • Fundoplication
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / surgery
  • Glucocorticoids / therapeutic use
  • Humans
  • Male
  • Proton Pump Inhibitors

Substances

  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Glucocorticoids
  • Proton Pump Inhibitors