Association of gastroesophageal reflux disease risk with exacerbations of chronic obstructive pulmonary disease

Abstract

Gastroesophageal reflux disease (GERD) may be a potential risk factor for exacerbations of chronic obstructive pulmonary disease (COPD). The aim of the present study was to explore the association of GERD risk with exacerbations of COPD. Patients with COPD were consecutively recruited, and COPD Assessment Test (CAT) and Reflux Diagnostic Questionnaire (RDQ) were administered. If the CAT score was 5 points higher than that taken in the stable states, the patient was considered as having exacerbations of COPD. A RDQ score of ≥ 12 is defined high GERD risk. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between high GERD risk and exacerbations of COPD. Among 386 patients with COPD, the mean CAT score was 18.3 ± 6.6, and 76 (19.7%) patients had exacerbations during the 1-year follow-up. The mean RDQ score was 10.1 ± 4.7, and 132 (34.2%) patients were identified as having high GERD risk. Multivariate logistic regression analyses revealed that the high GERD risk (odds ratio, 2.31; 95% confidence interval, 1.29-3.87) was an independent risk factor of COPD exacerbations. In conclusion, high GERD risk appears to be associated with higher odds for COPD exacerbations.

A 12‐month follow‐up study on the preventive effect of oral lansoprazole on acute exacerbation of chronic obstructive pulmonary disease

“…; Liang et al . ). GER refers to the reflux of contents from the stomach and duodenum to the oesophagus, mouth, throat or even the lower respiratory tract.…”

“…; Liang et al . ), which can be effectively treated with PPIs. Considering that rhinovirus infection is one of the causes of AECOPD, it has been found that lansoprazole can inhibit rhinovirus 14 activity in infected cultured airway epithelial cells by inhibiting the expression of ICAM‐1 and the acidification of these cells (Sasaki et al .…”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…In the ECLIPSE study, the best predictors for AECOPD, across all GOLD stages, were previous exacerbations and history of reflux or heartburn . The presence of gastroesophageal reflux disease (GERD) in COPD patients is associated with a seven time greater risk of AECOPD and a higher rate of hospitalisation or emergency room visits . There are several possible mechanisms by which GERD may influence the severity of COPD and the exacerbation rate.…”

“…First, gastric acid microaspiration induces a laryngeal or tracheal irritative response which results in vagally mediated bronchoconstriction, cough, dyspnea or wheezing and is followed by an inflammatory reaction with a systemic cytokine spill over. It has also been suggested that non‐acid reflux may also play an important role in vagally mediated bronchoconstriction . Second, GERD is also known to be associated with an increased bacterial load and colonisation of lower airways which increases the sensitivity to inflammation, infection and AECOPD .…”

Pneumologische Erkrankungen und gastroösophagealer Reflux

“…In einer anderen Studie hatten COPD-Patienten deutlich häufi-ger typische Refluxsymptome (25 vs. 9 %) [43], ein Déja vu aus der Asthma-Reflux-Epidemiologie. Es gibt auch dafür Hinweise, dass Reflux ein unabhängiger Risikofaktor für COPD-Exazerbationen ist [44]. Der gastroösophageale Reflux kommt auch bei Nicht-CF-Bronchiektasen (zystische Fibrose) überhäufig vor [42].…”