Role of gastroesophageal reflux in older children with persistent asthma.
BACKGROUND
Gastroesophageal reflux (GER) plays a role in inducing or exacerbating asthma.


METHODS
We evaluated asthma outcome before and after anti-GER treatment in older children (age range, 5 to 10.5 years) who had persistent moderate asthma and were being treated with short- and long-acting bronchodilators, inhaled corticosteroids, and leukotriene antagonists. Forty-six such consecutive children underwent extended esophageal pH monitoring. Of the 27 patients (59%) who had evidence of GER disease, 18 patients underwent medical treatment (lifestyle changes, proton pump inhibitors, and prokinetics) and 9 patients opted for surgical treatment (Nissen fundoplication) of GER. Of the 19 patients with normal pH study findings, 8 patients underwent empiric medical anti-GER treatment and the remaining 11 patients served as a control group. Data on all patients were collected from 6 months prior to performing the pH studies and for 12 months after initiation of anti-GER treatment. The frequency of oral and inhaled corticosteroids, short- and long-acting bronchodilators, and leukotriene antagonists was prospectively recorded.


RESULTS
There was a significant reduction in the use of short- and long-acting bronchodilators as well as inhaled corticosteroids after anti-GER treatment was instituted in patients with GER disease (p < 0.05). Two patients (25%) without evidence of GER disease showed significant reduction in need for asthma medication after anti-GER treatment, but none of the patients without GER disease and no GER treatment showed any significant reduction in the need for asthma medications.


CONCLUSIONS
Anti-GER treatment in patients with GER disease and asthma results in a significant reduction in the requirement of asthma medications.
Khoshoo
Vikram
V
West Jefferson Medical Center, New Orleans, LA, USA. vkhoshoo@earthlink.net
Le
Thao
T
Haydel
Robert M
RM
Landry
Lisa
L
Nelson
Carl
C
D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors
D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D054328:Proton Pump Inhibitors