title: The effects of concomitant GERD, dyspepsia, and rhinosinusitis on asthma symptoms and FeNO in asthmatic patients taking controller medications.
abstract: BACKGROUND
  Losing the sense of smell, which suggests eosinophilic rhinosinusitis, is a subjective symptom, sometimes reported in asthmatic patients taking controller medication. Upper abdominal symptoms, suggesting gastroesophageal reflux disease (GERD) or functional dyspepsia, occur also in these patients. However, the relationship between these symptoms, concomitant with asthma, and the intensity of eosinophilic airway inflammation remains obscure.
  
  
  OBJECTIVE
  To assess the symptoms of asthma and rhinosinusitis, and to examine the relationship between the symptoms and bronchial inflammation, a new questionnaire, the G scale, was developed. To investigate the effects of GERD, dyspepsia, and rhinosinusitis on asthma symptoms and bronchial inflammation, the symptoms of asthma and rhinosinusitis obtained by the G scale, upper abdominal symptoms obtained by the modified F scale, a questionnaire for GERD and dyspepsia, and fractional exhaled nitric oxide (FeNO) were analyzed.
  
  
  METHODS
  A prospective, observational study was performed in four hospitals in Gunma prefecture, and a retrospective analysis was done using data obtained from five hospitals in Gunma prefecture and Fukui prefecture, Japan. A total of 252 patients diagnosed as having asthma participated in the prospective study.
  
  
  RESULTS
  The frequency of daytime phlegm or losing the sense of smell had a positive correlation with FeNO levels in asthmatic patients taking controller medication. Upper abdominal symptoms, as well as symptoms suggesting rhinitis, were well correlated with asthma symptoms. However, neither upper abdominal symptoms nor rhinitis symptoms increased FeNO levels, which reflect eosinophilic airway inflammation during treatment for asthma. On the other hand, the degree of upper abdominal symptoms or dyspepsia symptoms had a weak but significant negative correlation with FeNO levels.
  
  
  CONCLUSIONS
  Daytime phlegm and losing the sense of smell suggest that eosinophilic airway inflammation persists, despite anti-inflammatory therapy, in patients with asthma. Although rhinitis and GERD made the subjective symptoms of asthma worse, they did not seem to enhance eosinophilic airway inflammation.
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan ; Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Ishizuka
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hisada
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kamide
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Seki
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Honjo
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Kadowaki
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Umeda
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Miwa
authors.initials: M
authors.lastname: Morikawa
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Anzai
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Ameshima
authors.affiliation: Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishizaki
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Dobashi
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Japan.
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kusano
keywords: FeNO; GERD; asthma symptoms; dyspepsia; rhinosinusitis