Gastro-oesophageal reflux treatment for asthma in adults and children.
BACKGROUND
Asthma and gastro-oesophageal reflux are both common medical conditions and often co-exist. Studies have shown conflicting results concerning the effects of lower oesophageal acidification as a trigger of asthma. Furthermore, asthma might precipitate gastro-oesophageal reflux. Thus a temporal association between the two does not establish that gastro-oesophageal reflux triggers asthma. Randomised trials of a number of treatments for gastro-oesophageal reflux in asthma have been conducted to determine whether treatment of reflux improves asthma.


OBJECTIVE
The objective of this review was to evaluate the effectiveness of treatments for gastro-oesophageal reflux in terms of their benefit on asthma.


METHODS
The Cochrane Airways Group trials register, review articles and reference lists of articles were searched.


METHODS
Randomised controlled trials of treatment for oesophageal reflux in adults and children with a diagnosis of both asthma and gastro-oesophageal reflux.


METHODS
Trial quality and data extraction were carried out by two independent reviewers. Authors were contacted for confirmation or more data.


RESULTS
Twelve trials met the inclusion criteria. Interventions included proton pump inhibitors (n=6), histamine antagonists (n=5), surgery (n=1) and conservative management (n=1). Treatment duration ranged from 1 week to 6 months. A temporal association between asthma and gastro-oesophageal reflux was investigated in 4 trials and found to be present in a proportion of participants in these trials. Anti-reflux treatment did not consistently improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications.


CONCLUSIONS
In asthmatic subjects with gastro-oesophageal reflux, (but who were not recruited specifically on the basis of reflux-associated respiratory symptoms), there was no overall improvement in asthma following treatment for gastro-oesophageal reflux. Subgroups of patients may gain benefit, but it appears difficult to predict responders.
Gibson
P G
PG
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, NSW, Australia. mdpgg@mail.newcastle.edu.au
Henry
R L
RL
Coughlan
J L
JL
D000328:Adult; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002648:Child; D020117:Cisapride / Q000627:therapeutic use; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic
D006633:Histamine Antagonists; D054328:Proton Pump Inhibitors; D020117:Cisapride