Impact of gastric reflux on asthma in clinical practice

Abstract

CORRESPONDENCE Impact of gastric reflux on asthma in clinical practiceTo the Editors:Porsbjerg and Menzies-Gow reviewed the clinical impact of co-morbidities on severe asthma management. 1 The European Respiratory Society/American Thoracic Society (ERS/ATS) guidelines on severe asthma and the Global Initiative for Asthma (GINA) document recommend a systematic assessment of potential co-morbidities in all patients with possible severe asthma. 2,3 Co-morbidities may significantly affect asthma control, both aggravating and mimicking symptoms. Thus, recognition of a co-morbidity is a crucial step in the workup of severe asthma.Gastric reflux (GR) is quite common in asthmatic patients, mainly in patients with severe asthma. Although this issue has been recently investigated Porsbjerg and Menzies-Gow, 1 some pathophysiological aspects remain obscure. We now present our retrospectively conducted clinical study of 188 (107 females) consecutive outpatients with asthma. The aim was to evaluate the impact of some demographic and clinical variables (body mass index (BMI), past smoking, GINA asthma control grade, sinonasal co-morbidity, respiratory symptoms in the current month, early onset of asthma, symptom perception assessed by visual To assess the association between GR with the considered variables, a univariate analysis was performed using the binary Firth's penalized-likelihood logistic regression. Significant covariates were selected for the multivariate analysis. The likelihood ratio (LR) test was used. Data were acquired and analysed in R v3.3.2 software environment. 4GR co-morbidity (GR+) was present in 41 (21.81%) of these outpatients. Table 1 shows the difference between GR+ and GR− subjects. GR was associated with early asthma onset and lower ACT values (P = 0.0098 and 0.0033, respectively). The multivariate analysis (Table 2) showed significant associations between GR, early asthma onset and ACT (P = 0.0197 and 0.0103, respectively).In conclusion, our findings confirm the heightened prevalence of GR in asthma and are consistent with previous studies showing the impact of GR on asthma control. Therefore, GR assessment can be recommended in asthmatic patients. ACT, asthma control test; beta, coefficient of regression; GR, gastric reflux; P-value, likelihood ratio P-value.Respirology (2018) 23, 230-231

Comorbidity of atopic diseases and gastro‐oesophageal reflux: evidence of a shared cause

“…The rates and risk ratios of asthma and GERD comorbidity reported in this Swedish adult twin population are commensurate with other large general population studies 8,35‐37 . In addition, our results support a number of studies which have found that GERD is a risk factor for asthma exacerbations and difficult to control asthma 3,38–41 . As far as we know our study is the first to report on asthma severity and GERD, the results do not support an association.…”

“…8,[35][36][37] In addition, our results support a number of studies which have found that GERD is a risk factor for asthma exacerbations and difficult to control asthma. 3,[38][39][40][41] As far as we know our study is the first to report on asthma severity and GERD, the results do not support an association. These results suggest that GERD is more likely to be associated with an asthma exacerbation rather than severity of asthma as defined by high dose medications GINA guidelines Step 4 and 5.…”

<p>Detection of pepsin and IL-8 in saliva of adult asthmatic patients</p>

“…This may be due to poor inhaler skills and adherence or confounding comorbidities such as obesity and gastroesophageal reflux disease (GERD). Several studies have demonstrated an increased prevalence of GERD in asthma patients and highlighted its impact on asthma control 5 , 6 . Studies are needed to identify subgroups of asthmatic patients that may benefit from anti-reflux therapy.…”