title: The Potential Role of Aspiration in the Asthmatic Airway.
abstract: Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control?
  
  
  
  Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with BAL pepsin measured as a marker of aspiration.
  
  
  
  Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ-7 or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations on the basis of BAL, there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ-7, Global Initiative for Asthma, exacerbation frequency or FEV1using either univariate or multivariate analyses.
  
  
  
  This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.
authors.affiliation: Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
authors.forename: Eoin B
authors.initials: EB
authors.lastname: Hunt
authors.affiliation: The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England.
authors.forename: Chris
authors.initials: C
authors.lastname: Ward
authors.affiliation: The Department of Radiology, Cork University Hospital, Cork, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Power
authors.affiliation: The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland.
authors.forename: Ashley
authors.initials: A
authors.lastname: Sullivan
authors.affiliation: The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Pearson
authors.affiliation: The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland.
authors.forename: Susan
authors.initials: S
authors.lastname: Lapthorne
authors.affiliation: The Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Paul M
authors.initials: PM
authors.lastname: O'Byrne
authors.affiliation: The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eustace
authors.affiliation: Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Plant
authors.affiliation: The Department of Radiology, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Maher
authors.affiliation: The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: MacSharry
authors.affiliation: Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland; The HRB Clinical Research Facility, University College Cork, Cork, Ireland. Electronic address: desmond.murphy@hse.ie.
authors.forename: Desmond M
authors.initials: DM
authors.lastname: Murphy
mesh_terms: D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D017609:Barium Compounds; D001944:Breath Tests; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D001999:Bronchoscopy; D004797:Enzyme-Linked Immunosorbent Assay; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015999:Multivariate Analysis; D009569:Nitric Oxide; D010434:Pepsin A / Q000032:analysis; D053120:Respiratory Aspiration / Q000453:epidemiology* / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D017609:Barium Compounds; D009569:Nitric Oxide; D010434:Pepsin A
keywords: aspiration; asthma; inflammation; reflux