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(Chest. 1999;116:843.)
© 1999 American College of Chest Physicians

Gastroesophageal Reflux and Respiratory Symptoms

Stephen K. Field, MD

University of Calgary, Calgary, Alberta, Canada

Correspondence to: Stephen K. Field, MD, Division of Respiratory Medicine, Foothills Hospital, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada

To the Editor:

I would like to commend Harding et al (March 1999)1 for publishing their extensive data on 24-h pH monitoring of asthma patients. Several authors have reported the occurrence of respiratory symptoms including cough, dyspnea, wheezing, and ß-agonist use in asthma patients in association with gastroesophageal reflux (GER) symptoms.2 3 The findings of Harding et al confirm the association between physiologic GER and the development of asthma symptoms.1

Despite the strong association between the two conditions, GER does not consistently worsen objective measures of pulmonary function in asthma and treating GER does not consistently improve them.4 5 A review of the medical literature on antireflux therapy demonstrates a paradox.5 Successful treatment of GER improves asthma symptoms and asthma medication requirements but does not improve pulmonary function.5 The data reported by Harding et al confirm that GER causes respiratory symptoms, despite the existence of other studies that fail to show consistent effects on pulmonary function.1 4 Recognizing the existence of this paradox may help to explain the nature of the relationship between the two conditions.

Previous authors have reported that GER can cause dyspnea and that medical antireflux therapy improves it in nonasthmatic patients with normal pulmonary function and negative results of methacholine challenge tests.6 7 Changes in ventilation may explain an improvement in respiratory symptoms without changes in pulmonary function.8 Similar changes in asthma patients could explain asthma symptoms and their response to antireflux therapy in the absence of changes in pulmonary function.4 5 The study by Harding et al emphasizes the need for further studies to determine which asthma patients require esophageal testing and which will benefit from antireflux therapy. Perhaps future studies of the effects of GER and antireflux therapy should focus on changes in asthma symptoms and quality of life rather than changes in pulmonary function.

References

  1. Harding, SM, Guzzo, MR, Richter, JE (1999) 24-h esophageal testing in asthmatics: respiratory symptom correlation with esophageal acid events. Chest 115,654-659[Abstract/Free Full Text]
  2. Ekstrom, T, Lindgren, BR, Tibbling, L (1989) Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study. Thorax 44,19-23[Abstract]
  3. Field, SK, Underwood, M, Brant, R, et al (1996) Prevalence of gastroesophageal reflux symptoms in asthma. Chest 109,316-322[Abstract/Free Full Text]
  4. Field, SK (1999) A critical review of the studies of the effects of simulated or real gastroesophageal reflux on pulmonary function in asthmatic adults. Chest 115,848-856[Abstract/Free Full Text]
  5. Field, SK, Sutherland, LR (1998) Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux?: a critical review of the litrature Chest 114,275-283[Abstract/Free Full Text]
  6. Pratter, M, Curley, FJ, DuBois, J, et al (1989) Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 149,2277-2282[Abstract]
  7. DePaso, WJ, Winterbauer, RH, Lusk, JA, et al (1991) Chronic dyspnea unexplained by history, chest roentgenogram, and spirometry: analysis of a seven-year experience. Chest 100,1293-1299[Abstract/Free Full Text]
  8. Field, SK, Evans, JA, Price, LM (1998) The effects of acid perfusion of the esophagus on ventilation and respiratory sensation. Am J Respir Crit Care Med 157,1058-1062[Abstract/Free Full Text]




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