Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis

Abstract

OBJECTIVE: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. METHODS: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. RESULTS: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). CONCLUSIONS: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.

Epidemiology and clinical impact of major comorbidities in patients with COPD

“…Importantly, 58% of the COPD patients with GERD were asymptomatic. As previously discussed, GERD is implicated in increasing exacerbations of COPD 16,38,47,139. At least one study has implicated GERD in decreased quality of life scores.…”

“…GERD is strongly associated with increased exacerbations 16,38,47,139. Cardiovascular disease, pulmonary embolism, depression, and anxiety have also been associated with increased hospitalizations.…”

Clinically relevant subgroups in COPD and asthma

“…More frequent exacerbations PPI, H2 receptor antagonist [45][46][47] This is not an exhaustive list of all conditions or treatments; where possible, references specific to COPD, major review articles or international guidelines on management have been cited rather than single studies. GORD: gastro-oesophageal reflux disease; ACE-I: angiotensin-converting enzyme inhibitor; HRQoL: health-related quality of life; CBT: cognitive behavioural therapy, PPI: proton-pump inhibitor.…”

Is gastro-oesophageal reflux associated with COPD exacerbations?

“…( 9 ) The review confirmed the association between exacerbations and GOR and showed that the risk of having a COPD exacerbation was seven times higher in GOR patients than in those without GOR. Furthermore, the authors also showed that patients with COPD have a significantly higher prevalence of GOR than those without COPD, emphasising that GOR is an important and common co-morbidity in COPD.…”