GER in Asthma and COPD
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Over 24 million Americans carry a diagnosis of asthma. Gastroesophageal reflux (GER) has been associated with asthma, given the high prevalence estimates reported from multiple major studies. The pathophysiology of GER in asthma is likely related to the shared embryonic roots of both the gastroesophageal and the tracheobronchial tracts along with their shared nervous system innervations. Multiple animal studies have shown that tracheal instillation of acid causes bronchial hyperreactivity, while denervation of the vagus nerve lessens this effect, and human studies have duplicated these findings. These observations led to multiple intervention trials where treatment of GER has often been associated with improvement in patient-related outcomes, but positive outcomes have not been consistent across trials. More importantly, there is no evidence to show that treating asymptomatic GER improves asthma control. In contrast to asthma, the pathophysiology of GER in COPD is less clear, as there are few studies that have examined the prevalence of GER in patients with COPD. Nonetheless, such studies suggest that GER is prevalent and may play a role in exacerbations encountered by patients with advanced COPD. Furthermore, a recent, nonrandomized small study demonstrated a decrease in exacerbations with empiric therapy using a proton pump inhibitor. We conclude that GER may play a significant role in the pathophysiology and disease morbidity of patients with asthma and COPD, and therapies that target abnormal GER may provide benefit to patients. However, larger studies are needed to elucidate the link between airway disease and GER, especially in patients with COPD.
KeywordsAsthma Gastroesophageal reflux Chronic obstructive pulmonary diseases Cough Microaspiration Asthma Lower esophageal sphincter
- 31.Gibson PG, Henry R, Coughlan JJL. Gastro-oesophageal reflux treatment for asthma in adults and children (Review). Cochrane Review. 2009; Issue 1.Google Scholar
- 35.Sasaki T, Nakayama K, Yasuda H, Yoshida M, Asamura T, Ohrui T, Arai H, Araya J, Kuwano K, Yamaya M. A randomized, single-blind study of lansoprazole for the prevention of exacerbations of chronic obstructive pulmonary disease in older patients. J Am Geriatr Soc. 2009;57(8):1453–7.PubMedCrossRefGoogle Scholar