Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux: Analysis

In: Asthma

8 Jun 2014

Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux: AnalysisThe subjects were divided into treatment responders and nonresponders. Improvement was defined by the presence of at least one of the following: asthma symptom score reduction of more than 20%, PEF improvement by more than 20%, total number of asthma medications required was reduced by more than 20%, or daily prednisone dose reduction by more than 40%. By these criteria, asthma improved in 22 subjects, but it worsened in the eight remaining patients despite an improvement in GER symptoms.
Analysis
Because the number of studies was relatively small, it was important to include all of the placebo-controlled, randomized studies in the analysis. The findings of the different studies are arranged by grade in Table 2 and the data from the individual studies are grouped by grade in Table 3.
None of the controlled studies were large enough to be designated as grade A studies. Buy antibiotics online add comment Eight studies with a total of 200 subjects were designated as grade B (Table 2). The three open studies and one study with an untreated control group were designated as grade C studies (Tables 1 and 2). The group B data showed that medical antireflux therapy improved asthma symptoms and asthma medication use but did not improve lung function (Fig 1). Although they were not included in the analysis, the group C results were similar to the Group B studies (Table 3).
If antireflux treatment were ineffective or inadequate, one would not expect a beneficial effect on asthma control. Figure 2 illustrates the effects of antireflux therapy on those patients with a documented improvement in symptomatic GER. Limiting the analysis to patients with a documented improvement in symptomatic GER did not alter the overall findings.
Discussion
Is there a consensus among the antireflux studies?
Given the attention to the relationship between GER and asthma, it is surprising that there have been only 12 published, peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthma. Comparison of the different studies is difficult because their designs have been so different. Because these studies were done over a 15-year period, the asthma medications used, doses and duration of therapy, and both the evaluation and treatment of GER have changed considerably. Moreover, the studies’ subject characteristics have differed. Two studies were done with pediatric patients, while the other studies used adults. The severity of asthma and the exclusion of atopic asthmatics has also varied between the studies.
Table 2—Effects of Antireflux Therapy

Grade Reference No ofSubjects SymptomaticGER AsthmaSymptoms AsthmaMedicationUse PEF Spirometry
B Larrain et al 55 N/A reduced reduced N/A unchanged
B Ekstrom et al 48 reduced reduced reduced unchanged unchanged
B Goodall et al 18 reduced reduced unchanged night only increased unchanged
B Nagel et al 15 unchanged unchanged unchanged unchanged N/A
B Gustafsson et al 18 N/A unchanged N/A unchanged unchanged
B Ford et al 11 unchanged unchanged unchanged unchanged N/A
B Meier et al 15 reduced* N/A N/A unchanged unchanged
B Teichtahl et al° 20 reduced unchanged unchanged night only increased unchanged
C Kjellen et al 62 reduced reduced reduced N/A unchanged
C Harper et al 15 reduced reduced N/A N/A improved
C Harding et al2° 30 reduced reduced unchanged unchanged unchanged
C Tucci et al 19 reduced reduced reduced N/A N/A

Table 3—Results of Studies of Antireflux Therapy in Asthma, Grouped by Grade

No. of Studies (Patients) With Improvement/No Improvement
Grade* Total No. of Studies (Patients) AsthmaSymptoms Asthma Medication Use PEF Spirometry
B 8(200) 3 (121)/4 (64) 2 (103)/4 (64) 2 (38)/5 (107) 0 (0)/6 (174)
GER improved 4(101) 2 (66)/l (20) 1 (48)/2 (38) 2 (38)/2 (63) 0 (0)/4 (101)
C 4(126) 4 (126)/0 (0) 2 (81)/1 (30) 0 (0)/l (30) 1 (15)/2 (92)
Total 12(326) 7 (247)/4 (64) 4 (184)/5 (94) 2 (38)/6 (137) 1 (15)/8 (266)

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