Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation

Abstract

Background: The association between gastro-oesophageal reflux disease (GORD) and chronic obstructive pulmonary disease (COPD) exacerbation has so far remained unclear. Objective: To prospectively establish the clinical significance of GORD symptoms on exacerbation. Methods: 82 patients with COPD and 40 age matched controls were enrolled in this study. Symptoms were evaluated by a questionnaire using the Frequency Scale for the Symptoms of GORD (FSSG). Patients with COPD were prospectively surveyed for 6 months, and episodes of exacerbation were identified using a diary based on modified Anthonisen's criteria. Exhaled breath condensate (EBC) pH was measured in both groups, and induced sputum was evaluated in patients with COPD. Results: Positive GORD symptoms were reported in 22 (26.8%) patients with COPD and in five (12.5%) controls (p = 0.10). The frequency of exacerbations was significantly associated with the FSSG score (p = 0.03, r = 0.24, 95% CI 0.02 to 0.43). Multiple regression analysis revealed that GORD symptoms were significantly associated with the occurrence of exacerbations (p,0.01; relative risk 6.55, 95% CI 1.86 to 23.11). EBC pH was inversely correlated with FSSG score in both groups (p = 0.01, r = -0.37, 95% CI -0.55 to 20.14 in patients with COPD, and p,0.01, r = -0.45, 95% CI -0.67 to 20.16 in control subjects). Conclusions: GORD symptoms were identified as an important factor associated with COPD exacerbation.

COPD comorbidities network

“…At lower p-values, less prevalent and connected nodes are lost with little changes seen within hubs. In fact, 23 comorbidities shown in table 2 hold 56, 69 or 72% of the links depending of the p-values cut-off used for significant association and interestingly many of those comorbidities have been shown to influence important outcomes as described in previous studies [13,14,17,19,20,42,43].…”

“…Using an unbiased approach, we constructed a graphic expression of the complex relationship between prevalence, connections between diseases and clinical variables, the presence of hubs and the clustering of comorbidities. Interestingly, the highly connected comorbidities ( figure 2 and table 2) are known to be associated with important patient-related outcomes [13,14,17,19,20,42,43]. If we assume that the COPD Comorbidity Network is similar in behaviour to common networks seen in daily life, like airports composed of important hubs with many incoming and outgoing connecting flights with less influential airports in minor destinations, then disruption of air traffic will be mostly felt when delays affect large hubs [44].…”

“…Comorbidities also influence important patient-centred outcomes, such as health status [14,15], response to therapeutic intervention [16], and frequent hospital readmissions [17,18]. The majority of studies of COPD comorbidities report the relationship between a single or small number of comorbidities [19][20][21][22]. The inclusion of multiple comorbidities provides a broader view of the complex interaction amongst them that may reveal previously unappreciated associations.…”

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…Indeed, data from the ECLIPSE study identified a history of heartburn or reflux as an independent predictor of frequent exacerbator status [8]. Prospectively identified exacerbation frequency was related to the frequency of reflux symptoms over a 6 month period [89]. This link between reflux and COPD exacerbations is an intriguing one, requiring further investigation.…”

Gastroesophageal Reflux Symptoms in Patients with Chronic Obstructive Pulmonary Disease

“…The severity of hyperinflation and dyspnea may be important associated risk factors for the incidence of GERD symptoms in patients with clinically stable COPD [14]. Terada et al, also concluded that GERD symptoms were identified as an important factor associated with COPD exacerbation [15][16][17].…”