In: Asthma2 Jun 2014
Conservative Therapy Including Alginates
Kjellen et al randomized patients with asthma and esophageal dysfunction, as evidenced by symptoms and abnormal manometry and/or a positive AP test, to receive either conservative therapy including alginates or no treatment. Untreated patients were given neither advice nor medication for their esophageal symptoms. After 2 months, 87% of the treatment group and 11% of the nontreatment group reported relief or improvement of their esophageal symptoms. Compared to the untreated group, respiratory symptoms that included dyspnea, wheezing, cough, and (3-agonist inhaler use were improved. However, spirometry and arterial blood gas results were unchanged.
Goodall et al compared 6 weeks of cimetidine, 1 g/d, to placebo in a randomized, double-blind, crossover study of 18 asthmatics with GER. Reflux and nighttime asthma symptom scores improved with cimetidine. PEF was monitored four times daily, but only nighttime PEF improved. The increase in nighttime PEFR was less than 10% and was statistically significant only at the 0.05 level. However, if a correction for repeated testing such as Bonferroni’s method were applied, the change in PEF may not have been significant. Moreover, (3-agonist use and pulmonary function did not improve.
Larrain and coworkers compared cimetidine, 1,200 mg/d for 6 months, with placebo in nonatopic asthmatics with GER in a randomized, blinded, parallel-design study. Asthma symptoms and medication use improved with cimetidine, but pulmonaiy function did not. The symptomatic improvement with cimetidine disappeared 2 months after the end of the study, and some of the cimetidine-treated patients subsequently underwent antireflux surgery.
Four ranitidine studies in asthmatics with GER have been published. Harper et al reported an open study in 15 patients with nonallergic asthma and symptomatic GER. Asthma and GER symptoms were compared before and after ranitidine, 300 mg/d for 8 weeks. Reflux symptoms improved promptly with therapy. Asthma symptoms improved more slowly. In the last week of treatment, the improvement in spirometric values reached statistical significance.
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