Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux: A Critical Review of the Literature

In: Asthma

29 May 2014

Mansfield et al demonstrated that AP increased airway resistance in dogs. The effect of AP was abolished by bilateral cervical vagotomy, which led the authors to propose that it was due to a vagally mediated reflex. A number of other authors have investigated the relationship between GER and asthma, with conflicting findings. Some studies have shown that GER or AP has a small effect on airflow and, although statistically significant, is likely not clinically significant. However, the findings of a number of other studies have been negative.
Some asthmatics have severe, symptomatic GER that requires treatment regardless of its effect on their asthma. However, the majority have relatively mild GER symptoms that can be managed with conservative measures and antacids. If GER plays an important role in asthma control, then the benefits of more intensive antireflux treatment, even for asthmatics with relatively mild or asymptomatic GER, may outweigh the sizeable costs. If GER plays an important role only in some asthmatics, then it is important to determine which features identify those who will benefit from antireflux treatment.
Many studies of the relationship between asthma and GER have been published since Kennedy drew attention to their association in 1962. Several recent reviews of asthma management, particularly in nocturnal asthma, have discussed the potential role of GER in this setting. cialis professional 20 mg

Irwin et al found that GER was the most common factor that contributed to making asthma control difficult. Approximately two thirds of the problem asthmatics, including 24% with clinically silent GER, responded favorably to medical antireflux therapy. The authors advocated evaluating all diffi-cult-to-control asthmatics for GER and aggressively treating it even if the patients had minimal or no reflux symptoms.
However, the newer, more effective antireflux medications are expensive and not without side effects. The cost and inconvenience of adding even more medication, for a group of patients who already require expensive chronic therapy would be justified only if a tangible benefit could be demonstrated. The purpose of this article is to review the available evidence of the effects of antireflux therapy on asthma control in asthmatics with GER.

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