title: Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study.
abstract: BACKGROUND
  Gastro-esophageal reflux disease (GERD) predisposes to airway disease through a vagally-mediated esophago-bronchial reflex. This study investigates this vagal response to esophageal acid perfusion.
  
  
  METHODS
  40 asthmatics with mild stable asthma participated. Each subject underwent spirometry and autonomic function testing (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) four times: a) before intubation, b) after intubation, and then immediately after perfusion with, in random order, c) concentrated lime juice solution (pH 2-3) and d) 0.9% saline. Subjects were blinded to the solution perfused.
  
  
  RESULTS
  Asthmatics were of mean (SD) age 34.3 years (1.3), and 67.5% of them were females. pH monitoring demonstrated that 20 subjects had abnormal reflux and 20 did not. In each group 10 subjects had a positive GERD symptom score. Following perfusion with acid compared to saline, all subjects showed significant decreases in FEV1 and PEFR and significant increases in the mean valsalva ratio and heart rate difference on deep breathing from baseline values, but no changes in FVC or heart rate ratio on standing. There were no significant differences in any of the parameters between subjects with and without reflux.
  
  
  CONCLUSIONS
  Acid stimulation of the distal esophagus results in increased parasympathetic activity and concomitant broncho-constriction in asthmatics irrespective of their reflux state. This strengthens the hypothesis that GER triggers asthma-like symptoms through a vagally mediated esophago-bronchial reflex and encourages a possible role for anti-cholinergic drugs in the treatment of reflux-associated asthma.
authors.forename: D Lakmali
authors.initials: DL
authors.lastname: Amarasiri
authors.forename: Arunasalam
authors.initials: A
authors.lastname: Pathmeswaran
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
authors.forename: Channa D
authors.initials: CD
authors.lastname: Ranasinha
mesh_terms: D000143:Acids / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D001249:Asthma / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000502:physiology; D016084:Bronchoconstriction / Q000187:drug effects / Q000502:physiology; D004947:Esophagus / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D010477:Perfusion; D012143:Respiratory Physiological Phenomena / Q000187:drug effects*; D012137:Respiratory System / Q000187:drug effects*; D014630:Vagus Nerve / Q000187:drug effects / Q000502:physiology; D055536:Vagus Nerve Stimulation / Q000379:methods; D014636:Valsalva Maneuver / Q000502:physiology
chemical_list: D000143:Acids