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Silent Gastroesophageal Reflux and Asthma: The Value of Empiric Acid Suppression Therapy

University of Utah Health Sciences Center, Salt Lake City, UT

PURPOSE: Asthma patients frequently complain of heartburn, dysphagia and other symptoms that suggest the presence of gastroesophageal reflux disease (GERD). Failure to treat acid reflux in this setting is usually associated with poor control of asthma. We questioned whether silent GERD exerts a similar effect on asthma control.

METHODS: Asthma patients have been prospectively enrolled in a database kept at the Utah Asthma Center since 1995. Criteria for enrollment include clinical asthma without concurrent disease that might obscure or confuse the diagnosis. Patients who have smoked within the last five years are excluded from the database, as are patients with a cumulative smoking history of five or more pack years, regardless of when they last smoked. We queried this database to find patients who presented with asthma and no history of any symptoms that suggested GERD. Patients taking H2 antagonists, antacids or proton pump inhibitors (PPI) at the time of presentation were excluded, as were patients with any mention of heartburn, waterbrash or dysphagia on review of systems. A total of 34 patients were identified.

RESULTS: Thirty-one patients were treated with acid suppression. Seven did not return for follow-up. Four patients showed no improvement in asthma symptoms, although GERD in one was subsequently documented by pH monitoring. Four other patients who received corticosteroids and/or leukotriene modifiers along with acid suppression showed improvement. In 17 patients (55%), the addition of acid suppression alone resulted in decreased symptoms of shortness of breath, improved exercise tolerance and decreased rescue inhaler use within three months. Most patients received twice daily PPI. Two patients improved on H2 antagonist therapy alone, while two others received a combination of PPI therapy and a nightly dose of an H2 antagonist.

CONCLUSION: Acid suppression should be considered in patients who fail to respond to asthma therapy, even in the absence of symptoms of GERD.

CLINICAL IMPLICATIONS: A trial of acid suppression may improve control of asthma symptoms in patients not responding to usual therapy.

DISCLOSURE: W.M. Samuelson, None.