Role of gastro-oesophageal reflux in severe asthma: Experience from the Wessex severe asthma cohort

Tariq, Kamran, Barber, Clair, Gove, Kerry, Rupani, Hitasha, Brown, Tom, Kurukulaaratchy, Ramesh, Chauhan, Anoop, Djukanovic, Ratko and Howarth, Peter (2015) Role of gastro-oesophageal reflux in severe asthma: Experience from the Wessex severe asthma cohort. European Respiratory Journal, 46 (Suppl 59), [PA4578].

Abstract

Introduction: Gastro-oesophageal reflux disease (GORD) is a common co-morbidity in severe asthmatics. Its role in the description of the disease process and its mechanisms remains to be confirmed.
Methods: We analysed the MRC Wessex severe asthma cohort data focussing on severe asthmatics. 324 patients were classified on the basis of treatment with anti-acid treatment (Proton pump inhibitors, H2 receptor blockers) as those with and without GORD. Data were analysed with appropriate statistical tests using SPSS and Graphpad Prism
Results: Gender distribution showed a prevalence of females compared to males (GORD-76.6% vs 23.4%; p<0.001) and high BMI in patients with GORD (p<0.001). GORD was associated with higher BTS management step (p<0.001), higher ACQ6 (p<0.001) and ACQ7 (p=0.001) scores, high HAD score (p=0.01) and lower AQLQ scores (p<0.001) but no significant difference in lung function. GORD patients were ca. twice as likely to be on prophylactic antibiotics (14.6% vs 7.2% p=0.04), suggesting poorer control and higher exacerbation rates. Patients with GORD also had higher median [range] number of hospital admissions in last 12 months (0 [0–2] vs.0 [0–0.2], p=0.01), unscheduled GP visits (p=0.03) and lifetime history of ICU admissions (p=0.03).
Conclusions: This study data highlights the importance of GORD as potentially describing a phenotype of asthma. Better definition of this phenotype has the potential to identify disease pathways associated with GORD that could help define new strategies for the management of severe asthma.

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Contributors

Author: Clair Barber

Author: Ramesh Kurukulaaratchy

Author: Ratko Djukanovic

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