Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation

Mixed patterns of reflux are evident, with distal reflux only, proximal reflux only, and a mix of both demonstrated.11,49,56,62 In those with COPD, the prevalence is five times greater than the non-COPD population for proximal and distal reflux.7,67 GERD can affect patients with moderate to very severe COPD.41,42,49,56,62,68 Although a detailed clinical history of symptom presentation is recommended,69 this method of diagnosis is reliant upon the provocation of symptoms by reflux events, which in the event of asymptomatic (clinically silent) reflux is not a reliable indicator. The presence of asymptomatic reflux (20%-74%) in COPD11,41,49,56,62 emphasizes the importance of objective confirmation of GERD in some individuals.

Pulmonary fibrosis

Recently, studies in cough have clearly demonstrated that blocking acid is not effective in the treatment of this condition [18, 19], reinforcing the hypothesis that non-acid, usually gaseous, reflux is the main aetiological agent leading to the afferent neuronal hypersensitivity which underlies cough hypersensitivity syndrome. This paradigm of gaseous reflux and sensory hypersensitivity explains almost all of the otherwise mystifying phenomena reported by patients with chronic cough. Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach.

Other respiratory disease: the problem of definitions

It is recommended to test for early lung diffusion and airway obstruction among GERD patients even in the absence of respiratory symptoms in order to avoid further complications. An asymmetrical fibrotic pattern on computed tomography (CT) scans may also be a potential indicator of microaspiration. Symptomatic reflux and GER on objective testing were higher for 32 IPF patients with more than 20 % asymmetrical fibrosis by CT scan, than for those without asymmetrical fibrosis (62.5 vs. 31.3 %).

In earlier studies, no definite association was observed between GER and pulmonary function [32 , 33 ]. Since then, prospective studies have added to our understanding of the relationship between GER and ILD in scleroderma. Marie et al. found that esophageal dysfunction, determined by use of manometry, was associated with a higher prevalence of ILD on CT imaging.

Although heartburn and regurgitation are known to be specific for RE [14], 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.

Oscillometry may be more sensitive than spirometry in the identification of these subtle abnormalities. GERD severity is associated with impairment of gas exchange (DLCO). Cumulatively, these studies suggest that medical and/or surgical therapy for GER may have a positive effect on important clinical variables for IPF, including supplemental oxygen requirement, progression of pulmonary function, and perhaps even survival. Because of the current lack of approved anti-fibrotic therapy for IPF, and the relative ease of treating reflux disease, many clinicians attempt empirical GER treatment.

In particular, it is still uncertain whether GER causes fibrosis, or fibrosis causes reflux. The former implies that repetitive injury caused by microaspiration, acidic or non-acidic, may be a source of epithelial damage, which in a genetically susceptible IPF host may result in poor wound healing and an exaggerated fibroproliferative response. Regarding the latter, some hypothesize that pulmonary fibrosis results in altered respiratory mechanics that can subsequently induce associated reflux disease.

COPD and Other Diseases

However, Garcia Rodriguez et al. [5] reported that the prevalence of GER increased according to the use of inhaled corticosteroids. In another study, the effect of medication was not statistically significant or hard to evaluate because COPD patients are usually treated with multiple medications and have both pulmonary and other systemic problems [7].

The Candida on the larynx has cleared up and I was advised to see my gastro doctor now for my voice and GERD. What is so odd is spicy foods do not give me heartburn nor indigestion.

These difficulties can sometimes lead to life-threatening respiratory complications. The patient’s history is an extremely important part of the diagnosis of GERD-associated asthma. The diagnosis is important to consider, however, because significant improvement in symptoms and in asthma control occurs with appropriately treated GERD.[16] Certain clinical clues can be helpful in identifying GERD-related asthma.

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