The effects of concomitant GERD, dyspepsia, and rhinosinusitis on asthma symptoms and FeNO in asthmatic patients taking controller medications

Abstract

BackgroundLosing the sense of smell, which suggests eosinophilic rhinosinusitis, is a subjective symptom, sometimes reported in asthmatic patients taking controller medication. Upper abdominal symptoms, suggesting gastroesophageal reflux disease (GERD) or functional dyspepsia, occur also in these patients. However, the relationship between these symptoms, concomitant with asthma, and the intensity of eosinophilic airway inflammation remains obscure.ObjectiveTo assess the symptoms of asthma and rhinosinusitis, and to examine the relationship between the symptoms and bronchial inflammation, a new questionnaire, the G scale, was developed. To investigate the effects of GERD, dyspepsia, and rhinosinusitis on asthma symptoms and bronchial inflammation, the symptoms of asthma and rhinosinusitis obtained by the G scale, upper abdominal symptoms obtained by the modified F scale, a questionnaire for GERD and dyspepsia, and fractional exhaled nitric oxide (FeNO) were analyzed.MethodsA prospective, observational study was performed in four hospitals in Gunma prefecture, and a retrospective analysis was done using data obtained from five hospitals in Gunma prefecture and Fukui prefecture, Japan. A total of 252 patients diagnosed as having asthma participated in the prospective study.ResultsThe frequency of daytime phlegm or losing the sense of smell had a positive correlation with FeNO levels in asthmatic patients taking controller medication. Upper abdominal symptoms, as well as symptoms suggesting rhinitis, were well correlated with asthma symptoms. However, neither upper abdominal symptoms nor rhinitis symptoms increased FeNO levels, which reflect eosinophilic airway inflammation during treatment for asthma. On the other hand, the degree of upper abdominal symptoms or dyspepsia symptoms had a weak but significant negative correlation with FeNO levels.ConclusionDaytime phlegm and losing the sense of smell suggest that eosinophilic airway inflammation persists, despite anti-inflammatory therapy, in patients with asthma. Although rhinitis and GERD made the subjective symptoms of asthma worse, they did not seem to enhance eosinophilic airway inflammation.

Factors affecting compliance and control of asthma in patients attending the Respiratory Outpatient Department, Chris Hani Baragwanath Academic Hospital

“…Interestingly, despite the increased use of oral CSs in the uncontrolled group, there was no significant increase in CS-associated diseases, for example diabetes, obesity and hypertension. As has been found internationally, [13] GERD was noted in our study population. However, our figure of 33% of asthmatics with GERD is relatively low and there was no observed increase in its prevalence within either the uncontrolled or the partially controlled groups compared with the controlled group.…”

“…It may be of interest to closely interrogate and examine the patients in the two poorly controlled groups for GERD, although the contribution of concomitant GERD with asthma may vary according to the asthma phenotype, and not with the level of control. [13] Allergic rhinitis was found in only 20.3% of the cohort, considerably lower than the 67% found in a Japanese study. [13] Allergic rhinitis was more commonly diagnosed in the controlled group compared with the uncontrolled group (p=0.023), in conflict with the Japanese data which described allergic rhinitis as an aggravating factor for poorer control.…”

“…[13] Allergic rhinitis was more commonly diagnosed in the controlled group compared with the uncontrolled group (p=0.023), in conflict with the Japanese data which described allergic rhinitis as an aggravating factor for poorer control. [13] However, allergic rhinitis may be under-diagnosed in the poorly controlled groups.…”

Asthma and Obstructive Sleep Apnea

“…After microaspiration, the airway mucosa is injured by gastric contents, which can also induce or worsen asthma. [ 57 ]…”

Rapid Effect of Benralizumab for Hypereosinophilia in a Case of Severe Asthma with Eosinophilic Chronic Rhinosinusitis

“…ECRS is an important factor influencing asthma control. Fractionated expiratory nitric oxide (FeNO) levels correlate with eosinophilic airway inflammation in asthma and are elevated in uncontrolled asthma [6] and/or comorbidities, including allergic rhinitis, rhinosinusitis, and gastroesophageal reflux disease [7,8]. Notably, patients with well-controlled asthma exhibit elevated FeNO levels when ECRS is also present, but not when ECRS is absent [9].…”