title: Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To determine factors, overall and by sex, associated with self-reported gastro-oesophageal reflux disease (GORD) in chronic obstructive pulmonary disease (COPD) patients, and to evaluate relationships between GORD, its modification by acid suppression medications (Proton Pump Inhibitors [PPI]/histamine-2 receptor antagonists [H2RA]) and exacerbations of COPD and mortality.
  
  
  METHODS
  Logistic regression was used to determine factors associated with GORD; Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for GORD and risk of exacerbation and death.
  
  
  RESULTS
  Among 2135 COPD patients from the ECLIPSE cohort, 547 patients self-reported GORD, with female preponderance; 237 were taking PPI/H2RA. Risk factors for GORD did not differ by sex. When compared to patients who did not report GORD or use of PPI/H2RA, patients with GORD and taking PPI/H2RA had a significantly increased risk of exacerbation (HR = 1.58, 95%CI = 1.35-1.86); risk was also increased for patients reporting GORD only or PPI/H2RA use only (HR = 1.21 [1.04-1.40] and 1.33 [1.08-1.65], respectively). Similar findings were observed for risk of hospitalised exacerbation. GORD was not associated with mortality.
  
  
  CONCLUSIONS
  GORD in COPD patients is highly prevalent, and risk factors did not differ by sex. Use of PPI/H2RA and self-reported GORD were associated with increased risk of moderate-to-severe and hospitalised exacerbations.
authors.affiliation: Respiratory Epidemiology, GSK R&D, Uxbridge, United Kingdom.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Benson
authors.affiliation: Respiratory Epidemiology, GSK R&D, Uxbridge, United Kingdom.
authors.forename: Hana
authors.initials: H
authors.lastname: Müllerová
authors.affiliation: Centre for Respiratory and Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.affiliation: Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.affiliation: UCL Respiratory Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, United Kingdom.
authors.forename: Anant
authors.initials: A
authors.lastname: Patel
authors.affiliation: UCL Respiratory Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, United Kingdom. Electronic address: j.hurst@ucl.ac.uk.
authors.forename: John R
authors.initials: JR
authors.lastname: Hurst
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology*; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Chronic obstructive pulmonary disease; Cohort study; Epidemiology; Gastro-oesophageal reflux disease