Possible mechanisms of influence of esophageal acid on airway hyperresponsiveness

Stein, Mark R.

doi:10.1016/s0002-9343(03)00194-3

Cited by 82 publications

(63 citation statements)

References 26 publications

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“…Bronchial obstruction by methacholine can trigger or aggravate GER through an increase in transient lower esophageal sphincter (LES) relaxations (11,24). This association may indicate a dysfunction of the vagal nerve during the nighttime in asthmatic subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the reported number of reflux episodes occurring during 24-h esophageal pH monitoring, airway hyperresponsiveness to methacholine challenge tends to increase as GER worsens (11). The mechanisms of symptoms with GER are suggested to be tissue injury by microaspiration, vagal reflux, and neuroinflammatory reflux through the release of tachykinins, including substance P and neurokinin A (12,13).…”

Section: Introductionmentioning

confidence: 99%

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A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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: Salivary pH is associated with esophageal acid reflux and neutralization of esophageal acid. In this study, we assessed the association between nocturnal decline of salivary pH and airway hyperresponsiveness. Salivary pH was serially assessed in 9 patients with mild asthma (7 men and 2 women ; mean age 33.3 years ; mean % %predicted FEV1.0 89.4% %) and 10 healthy volunteers (6 men and 4 women ; mean age 31.2 years) using a pH indicator tape. The buffering capacity of saliva was defined as the median effective dose (ED50) for acidification of saliva with 0.01 N HCl, and airway responsiveness was defined as the dose of methacholine producing a 35% % fall in Grs (PD35-Grs). There was a significant correlation between the values obtained from the pH indicator tape and those obtained from the electrometric pH meter. Using the indicator tape for sequential monitoring, we observed a nocturnal fall (!pH) in salivary pH in all subjects. A significant correlation was found between airway hyperresponsiveness (PD35-Grs) and either !pH or ED50 in mildly asthmatic patients. Vagal reflux dysfunction might contribute to nocturnal salivary pH as well as to airway hyperresponsiveness in mild asthmatics. J. Med. Invest.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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“…A large body of research has examined the relationship between GERD and asthma, and while laryngeal irritation due to proximal GER produces cough and laryngospasm, distal GER alone may also produce functional changes in the respiratory tract. Animal [24] and human studies [25] confirm that distal GER may increase airways resistance and promote airway inflammation by releasing pro-inflammatory mediators [25]. FIELD et al [26] also showed that oesophageal acid increases minute ventilation, suggesting another mechanism for respiratory symptoms in GERD patients.…”

Section: Mechanisms Of Respiratory Disease In Gerdmentioning

confidence: 99%

Gastro-oesophageal reflux disease and non-asthma lung disease

Morehead¹

2009

European Respiratory Review

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Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

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“…23 Patients with asthma who have documented gastroesophageal reflux have greater airway responsiveness, which tends to increase as gastroesophageal reflux worsens. 24 Gastroesophageal reflux is also associated with greater bronchial reactivity in individuals without asthma. 25 It is theorized that the association of gastroesophageal reflux and asthma may be secondary to chronic microaspiration of stomach acids into the airways, with resulting inflammation of the airways and, in effect, an intrinsic cause of RADS.…”

Section: Potential Treatment Errors and Consequencesmentioning

confidence: 99%

Can Reactive Airways Dysfunction Syndrome (RADS) Be Iatrogenic?

Hewitt¹

2011

Respir Care

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Reactive airways dysfunction syndrome (RADS) is an asthma-like illness that develops after a single high-level exposure to a pulmonary irritant. Two different cases are reviewed, in which the exposure circumstances were not sufficient to result in adverse health effects yet resulted in persistent respiratory symptoms and a clinical diagnosis of RADS. Potential explanations for an erroneous diagnosis of RADS included an incomplete exposure assessment, medication adverse effects that can contribute to respiratory symptoms, and alternative explanations for respiratory symptoms or test findings. In particular, the empirical use of bronchodilator medications without a clear indication appeared to contribute to continued respiratory symptoms. Without a clear understanding of the patient's exposure, a RADS diagnosis should be carefully considered. The possibility of an iatrogenic sequence of events in which medication adverse effects facilitate respiratory symptoms and a mistaken RADS diagnosis should be considered, particularly in patients who have a poorly defined exposure history.

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Possible mechanisms of influence of esophageal acid on airway hyperresponsiveness

Cited by 82 publications

References 26 publications

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

Gastro-oesophageal reflux disease and non-asthma lung disease

Can Reactive Airways Dysfunction Syndrome (RADS) Be Iatrogenic?

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