2004 Volume 55 Issue 5 Pages 380-386
Recently, clinicians' awareness of gastroesophageal reflux disease (GERD) as a cause of chronic cough and asthma has increased. Several mechanisms have been implicated in GERD-induced pulmonary diseases. These include vagally mediated reflux triggered by acid in the esophagus and microaspiration of gastric acid. Postnasal drip, asthma and GERD are the causes of chronic cough in 86% of patients in Europe and the USA. In addition, it has been reported that coughing is the only symptom of the subclinical GERD patients. We found, by endoscopic examination, that 86.3% of asthmatics over the age of 50 simultaneously have grade M or higher GERD according to Los Angels classification.
With respect to treatment, studies using proton pump inhibitors to control acid reflux have demonstrated improvement in asthma symptoms. In our examination, we applied an asthmatic PPI, and improvement of peak expiratory flow was noted in 2 of 3 examples after 4-8 weeks.
Although we cannot conclude clearly that GERD aggravates chronic respiratory disease, available data support the need for active consideration of GERD and treatment in patients with chronic cough and asthma. Further studies should be multicentered and placebo-controlled using acid-suppressive therapy to clarify this point.
