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* From the Division of Respirology, Department of Medicine (Dr. Field), and the Division of Thoracic Surgery, Department of Surgery (Drs. Gelfand and McFadden), University of Calgary Medical School, Calgary, Alberta, Canada. Supported by the Foothills Hospital Foundation.
Correspondence to: Dr. Stephen K. Field, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada, T2N 2T9; e-mail: sfield{at}ucalgary.ca
Background: Antireflux therapy, including surgery, has been advocated for asthma patients with gastroesophageal reflux (GER). A recent review of medical antireflux therapy reported improvements in asthma symptoms and medication requirements but no improvement in pulmonary function. The purpose of this article is to review the available literature on the effects of antireflux surgery in asthma.
Method: Using the Medline 1966 to August 1998 database, lung disease, asthma, and pulmonary function were combined with GER and different antireflux surgeries, including fundoplication. Reference lists of identified articles were also reviewed.
Results: Combining the terms asthma and GER identified 271
articles, including 193 in English. Searching the term fundoplication
identified 497 articles, including 413 in English. Twenty-four reports
addressed the effects of antireflux surgery in asthma. Only two studies
were controlled. Asthmatic data could not be distinguished from that of
other subjects in five articles. The remainder were case series,
retrospective reviews, or uncontrolled studies. Ten reports included
data on 
10 patients. Two studies were only published as abstracts.
A total of 417 asthma patients were included in the identified reports.
Antireflux surgery improved GER symptoms, asthma symptoms, asthma
medication use, and pulmonary function in 90%, 79%, 88%, and 27%,
respectively.
Conclusions: Antireflux surgery may improve GER and asthma symptoms and decrease medication requirements, but it has little effect on pulmonary function. The effects of antireflux surgery on asthma are similar to those of medical antireflux therapy.
Key Words: asthma • bronchial reactivity • cough • dyspnea • esophageal surgery • esophagitis • fundoplication • gastroesophageal reflux • hiatus hernia • pH monitoring
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