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* From the Division of Pulmonary and Critical Care (Drs. Mokhlesi and Kamp), Department of Preventive Medicine (Ms. Huang), and Division of Gastroenterology, Department of Medicine (Dr. Barrett), Northwestern University Medical School, Chicago, IL; the Division of Pulmonary and Critical Care (Drs. Mokhlesi, Kamp, and Mr. Morris), Veterans Administration Chicago Healthcare System, Lakeside Division, Chicago, IL; and TAP Pharmaceuticals (Mr. Curcio), Deerfield, IL. * From the Service de Pneumologie (Drs. Marchand, Delaunoois, Brancaleone, and Vandenplas), Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Yvoir; Service de Pneumologie (Dr. Mairesse), Clinique Saint-Luc, Bouge; and Centre de Génétique Humaine et Unité de Génétique Médicale (Drs. Verellen-Dumoulin and Rahier), Université Catholique de Louvain, Brussels, Belgium.
Correspondence to: Eric Marchand, MD, Service de Pneumologie, Cliniques Universitaires de Mont-Godinne, 5530-Yvoir, Belgium; e-mail: eric.marchand{at}pneu.ucl.ac.be
Study objectives: To determine the prevalence of gastroesophageal reflux (GER) symptoms in patients with COPD and the association of GER symptoms with the severity of airways obstruction as assessed by pulmonary function tests (PFTs).
Design: Prospective questionnaire-based, cross-sectional analytic survey.
Setting: Outpatient pulmonary and general medicine clinics at a Veterans Administration hospital.
Patients: Patients with mild-to-severe COPD (n = 100) were defined based on American Thoracic Society criteria. The control group (n = 51) consisted of patients in the general medicine clinic without respiratory complaints or prior diagnosis of asthma or COPD.
Intervention: Both groups completed a modified version of the Mayo Clinic GER questionnaire.
Results: Compared
to control subjects, a greater proportion of COPD patients had
significant GER symptoms defined as heartburn and/or regurgitation once
or more per week (19% vs 0%, respectively; p < 0.001), chronic
cough (32% vs 16%; p = 0.03), and dysphagia (17% vs 4%;
p = 0.02). Among patients with COPD and significant GER symptoms,
26% reported respiratory symptoms associated with reflux events,
whereas control subjects denied an association. Significant GER
symptoms were more prevalent in COPD patients with FEV1
50%, as compared with patients with FEV1 > 50% of
predicted (23% vs 9%, respectively; p = 0.08). In contrast, PFT
results were similar among COPD patients with and without GER symptoms.
An increased number of patients with COPD utilized antireflux
medications, compared to control subjects (50% vs 27%, respectively;
p = 0.008).
Conclusions: The questionnaire demonstrated a higher prevalence of weekly GER symptoms in patients with COPD, as compared to control subjects. There was a trend toward higher prevalence of GER symptoms in patients with severe COPD; however, this difference did not reach statistical significance. We speculate that although GER may not worsen pulmonary function, greater expiratory airflow limitation may worsen GER symptoms in patients with COPD.
Key Words: COPD • FEV1 • gastroesophageal reflux disease • questionnaire
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