Prevalence of Gastroesophageal Reflux in Difficult Asthma

Leggett, Julian; Johnston, Brian T.; Mills, Moyra; Gamble, J.; Heaney, Liam G.

doi:10.1016/s0012-3692(15)34471-8

Cited by 52 publications

(50 citation statements)

References 24 publications

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“…However, the latter possibility may have important implications. Clinical studies in humans suggest that up to 80% of patients with asthma display concomitant signs of gastroesophageal reflux disease (23,30,34). In many asthmatic patients, at least some improvement of their asthmatic symptoms is achievable with effective pharmacological or surgical treatment of their reflux (24,31).…”

Section: L413mentioning

confidence: 99%

Innervation of tracheal parasympathetic ganglia by esophageal cholinergic neurons: evidence from anatomic and functional studies in guinea pigs

Mazzone

McGovern

2010

American Journal of Physiology-Lung Cellular and Molecular Phys

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In the present study, we describe a subset of nerve fibers, characterized by their immunoreactivity for the calcium-binding protein calretinin, that are densely and selectively associated with cholinergic postganglionic neurons in the guinea pig tracheal ganglia. Retrograde neuronal tracing with cholera toxin B, combined with immunohistochemical analyses, showed that these nerve fibers do not originate from sensory neurons in the nodose, jugular, or dorsal root ganglia or from motor neurons in the nucleus ambiguus, dorsal motor nucleus of the vagus nerve, spinal cord, stellate ganglia, or superior cervical ganglia. Calretinin-immunoreactive nerve fibers disappeared from tracheal segments after 48 h in organotypic culture, indicating that the fibers were of extrinsic origin. However, calretinin-positive nerve fibers persisted in tracheal ganglia when tracheae were cocultured with the adjacent esophagus intact. Immunohistochemical analysis of the esophagus revealed a population of cholinergic neurons in the esophageal myenteric plexus that coexpressed calretinin. In functional studies, electrical stimulation of the esophagus in vitro evoked measurable contractions of the trachea. These contractions were not altered by prior organotypic culture of the trachea and esophagus to remove the extrinsic innervation to the airways but were significantly (P < 0.05) inhibited by the ganglionic blocker hexamethonium or by physical disruption of the tissue connecting the trachea and esophagus. These data suggest that a subset of esophageal neurons, characterized by the expression of calretinin and acetylcholine, provide a previously unrecognized excitatory input to tracheal cholinergic ganglia in guinea pigs.

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Section: L413mentioning

confidence: 99%

Innervation of tracheal parasympathetic ganglia by esophageal cholinergic neurons: evidence from anatomic and functional studies in guinea pigs

Mazzone

McGovern

2010

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…Leggett et al [14] studied 42 patients with difficult to control asthma, and found that GERD was the most common factor that contributed to making asthma difficult to control. GERD was a definite factor in 64% of asthmatics who had a favorable response to medical antireflux therapy.…”

Section: Discussionmentioning

confidence: 99%

Value of proton pump inhibitors therapy in patients having GERD concurrent with uncontrolled asthma

Alkhayat

Mohamed

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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Objective: To study the effect of gastroesophageal reflux disease (GERD) management by using high dose of proton pump inhibitors (PPIs) on the outcome of uncontrolled asthma.Study design: The study included 100 patients with their ages ranging from 21 to 69 years. They presented with uncontrolled asthma (FEV1 less than 80%, with daily rescue medications and more than one urgent care visit/year). And all patients were on high dose of inhaled oral corticosteroid (more than 880 lg fluticasone).F-scale questionnaire was done for the diagnosis of GERD. Patients with GERD and bronchial asthma received PPIs (40 mg omeprazole) and inhaled oral corticosteroid (500 lg fluticasone with long acting beta-2 agonist 100 lg salmeterol) for 3 months.Results: Thirty-one (31%) patients showed combined GERD and bronchial asthma. Twentythree patients showed significant improvement in asthma control after combined therapy (p value 0.01).Twenty-three patients showed significant improvement in lung function (FEV1 more than 80%), maintained moderate dose of inhaled corticosteroid without rescue medication (p value 0.01).Conclusion: GERD is an important cause of uncontrolled asthma and its management significantly improves the uncontrolled asthma and significantly reduces the inhaled oral corticosteroid.

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“…GERD and rhinitis are exceedingly common in SA [5,8,30,31]. Moderate to severe rhinitis has been reported to be a predictor of uncontrolled asthma [32].…”

Section: Gastroesophageal Refl Ux Disease and Rhinitismentioning

confidence: 99%

“…Although a causal association between these common comorbidities and diffi cult-to-control asthma is tantalizing and plausible, it has not been proven. There is confl icting evidence regarding whether treating GERD and rhinitis in milder forms of asthma can lead to improved control [8,9,30], but consensus standard-of-care recommendations indicate that they should be treated aggressively if present. SA with concurrent rhinitis should be treated with intranasal corticosteroids.…”

Section: Gastroesophageal Refl Ux Disease and Rhinitismentioning

confidence: 99%

Severe asthma: What makes it so hard to manage?

Carlstrom

Castro²

2009

Curr Allergy Asthma Rep

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Severe asthma presents significant management challenges. Patients can be difficult to control despite use of current standard-of-care therapy, including inhaled corticosteroids and long-acting beta-agonists. Alternative diagnoses, noncompliance, and comorbidities all can influence asthma control, future risk, and response to currently available therapy. Definitions of severe asthma evaluate and address these confounding variables, and yet patients are still symptomatic despite aggressive, appropriate therapy. Severe asthma has a distinct pathophysiology including airway remodeling that contributes to the decreased effectiveness of standard therapy. Multiple phenotypes exist within severe asthma that likely require distinct therapeutic approaches to achieve control and improve long-term health outcomes. New therapeutic approaches to these distinct phenotypes will improve our understanding and treatment of this difficult-to-manage disease.

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Prevalence of Gastroesophageal Reflux in Difficult Asthma

Cited by 52 publications

References 24 publications

Innervation of tracheal parasympathetic ganglia by esophageal cholinergic neurons: evidence from anatomic and functional studies in guinea pigs

Innervation of tracheal parasympathetic ganglia by esophageal cholinergic neurons: evidence from anatomic and functional studies in guinea pigs

Value of proton pump inhibitors therapy in patients having GERD concurrent with uncontrolled asthma

Severe asthma: What makes it so hard to manage?

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