On this basis, we theorized that in patients with COPD, who also have gastro esophageal reflux disease are at increase risk for acute exacerbations of COPD. To test this question, we will determine which COPD patients have GERD by 24 hour pH testing, treat their GERD with esomeprazole or lansoprazole for 1 year, and compare the number of COPD exacerbations during the treatment period to the previous year. Gastroesophageal reflux disease (GERD) may cause, trigger or exacerbate many pulmonary diseases. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. A primary care physician often encounters patients with extra esophageal manifestations of GERD in the absence of heartburn.
Furthermore, use of GERD medication was associated with a lower radiographic fibrosis score. Although these results suggest that treatment of GERD may confer a survival benefit, it is possible that non-randomized patients receiving GERD therapy may also receive other valuable interventions, for example pulmonary rehabilitation and pneumonia vaccinations.
This clinical review examines the potential pathophysiological mechanisms of pulmonary manifestations of GERD. It also reviews relevant clinical information concerning GERD-related chronic cough and asthma. Finally, a potential management strategy for GERD in pulmonary patients is discussed.
Although more research is needed to determine why people with COPD have a higher risk of GERD, studies suggest that the severity of hyperinflation in the lungs and dyspnea (labored breathing) play a role. GERD also appears to be closely associated with COPD exacerbation. If you have GERD, you may even be at higher risk for hospitalization because your COPD suddenly gets worse. Research shows that more than one-quarter of those with COPD also have GERD, making it more common in people with COPD than it is in people who don’t have COPD. Women who had been diagnosed with COPD are more likely to have GERD than men.
Although heartburn and regurgitation are known to be specific for RE , only heartburn predicted RE statistically in this study. There are many patients with UGI diseases in Korea, and diseases other than RE were identified in 81% of our subjects. Most COPD patients are elderly and current or ex-smokers.
The Connection between COPD and GERD
It is not clear how cough is caused or aggravated by GERD. Not everyone with GERD has heartburn, but the primary symptoms of GERD are heartburn, regurgitation, and an acid taste in the mouth. Although research has shown a relationship between asthma and GERD, the exact link between the two conditions is uncertain.
Smokers and former smokers are at risk of developing COPD. COPD is short for chronic obstructive pulmonary disease – the new name for emphysema and chronic bronchitis. A cough that has lasted a long time is a symptom of COPD. A simple breathing test called spirometry is used to help diagnose COPD.
If a COPD patient underwent EGD, this indicates that the patient already had symptoms or at least was concerned about UGI disease. Thus, the prevalence would be overestimated. Nevertheless, because there has been no report of RE using EGD in COPD patients, this may also be a strength.
Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease
On the other hand, patients with esophagitis are more likely to have asthma than patients without esophagitis. In the ProGERD study, the occurrence of asthma depended on longer GERD duration and was more prominent in male and older subjects. The kind of GERD disease, weight and gender did not have significant relationship with asthma. A recent systematic review of 28 epidemiological studies found a 59.2% weighted average prevalence of GERD symptoms in asthmatic patients, compared to 38.1% in controls. The corresponding prevalence of asthma in GERD patients was 4.6%, compared to 3.9% in controls. One longitudinal study showed a significant association between a diagnosis of asthma and a subsequent diagnosis of GERD, whereas the two studies that assessed whether GERD precedes asthma gave inconsistent results. The prevalence of reflux symptoms was similar (75%) in a subgroup of patients with difficult-to-control asthma. A large population-based epidemiologic investigation showed that young adults with nocturnal reflux symptoms had a higher prevalence of asthma and respiratory symptoms as compared with patients without reflux symptoms. Another study by Sontag et al. showed that asthmatics had more frequent and more severe daytime as well as nighttime reflux symptoms and suffered from more reflux-related nocturnal awakening from sleep.
Causes of GERD
In patients with postnasal drip, clearly the reflux is irritating the nasal passages and sinuses. Those with an asthmatic (although not classic asthmatic) cough have an eosinophilic inflammation precipitated by the airway reflux. Of the majority who have chronic neutrophilic inflammation, some may have symptoms of acid reflux, but since acid is not the aetiological agent, heartburn and indigestion should be viewed as a comorbidities. Difficulty breathing is one of the more frightening symptoms of acid reflux and the chronic form of the condition, which is called gastroesophageal reflux disease (GERD). GERD can be associated with breathing difficulties such as bronchospasm and aspiration.