title: Prevalence of gastro-esophageal reflux disease in patients with difficult to control asthma and effect of proton pump inhibitor therapy on asthma symptoms, reflux symptoms, pulmonary function and requirement for asthma medications.
abstract: BACKGROUND
  The hypothesis that GER can trigger or exacerbate asthma is supported by several clinical trials that have shown amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy.
  
  
  OBJECTIVE
  To investigate the prevalence of GER in patients with difficult to control asthma and to determine the effect of omeprazole on asthma symptoms, reflux symptoms, pulmonary function and on the requirement of asthma medications.
  
  
  METHODS
  Patients with difficult to control asthma were recruited into the study. All patients underwent esophageal manometry and 24 hour esophageal pH monitoring. Pulmonary function tests were done before and after treatment. The severity of asthma and reflux was assessed by a 1 week pulmonary symptom score(PSS) and reflux symptom score(RSS) respectively before and after treatment. Those who had an abnormal pH study (pH <4 in the distal esophagus for >5% of the time) underwent anti-GER treatment with lifestyle changes, and a proton pump inhibitor (omeprazole 40 mg, bid) for 3 months. Asthma medications were added or deleted based on severity of asthma.
  
  
  RESULTS
  Out of 250 asthmatic patients screened, forty patients fulfilled the inclusion criteria. Twenty eight of 40 patients(70%) were diagnosed to have GERD. Of the patients 28 with GER, 8 patients(28.5%) had no reflux symptoms. On 24 hr pH metry, the percentage time pH <4.0 was 10.81 ± 4.72 and 1.11 ± 1.21; Deemester score was 37.65 ± 14.54 and 4.89 ± 6.39 (p-value is 0.0001) in GERD and non-GERD patients respectively.In GERD group, post treatment reflux symptom score(RSS) improved from 22.39 ± 14.99 to 1.04 ± 1.07, pulmonary symptom score(PSS) improved from 27.14 ± 7.49 to 13.82 ± 4.21 and night time asthma symptom score(NASS) improved from 6.71 ± 1.80 to 3.04 ± 1.23 (p-value <0.0001). After treatment, FEV1 and PEFR increased from 1.38 ± 0.57 and 4.14 ± 1.97 to 1.47 ± 0.54 and 5.56 ± 1.72, respectively (p-value 0.00114).
  
  
  CONCLUSIONS
  PPI therapy improves nocturnal asthma symptoms, daytime asthma symptoms, pulmonary function and decreases requirement of asthma medications in these patients.
authors.forename: V
authors.initials: V
authors.lastname: Sandur
authors.forename: M
authors.initials: M
authors.lastname: Murugesh
authors.forename: V
authors.initials: V
authors.lastname: Banait
authors.affiliation: Department of Gastroenterology, TNMC - BYL, Nair Hospital, Mumbai, India.
authors.forename: P M
authors.initials: PM
authors.lastname: Rathi
authors.forename: S J
authors.initials: SJ
authors.lastname: Bhatia
authors.forename: J M
authors.initials: JM
authors.lastname: Joshi
authors.forename: A
authors.initials: A
authors.lastname: Kate
mesh_terms: D000293:Adolescent; D000368:Aged; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005540:Forced Expiratory Flow Rates; D005541:Forced Expiratory Volume / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D015995:Prevalence; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole