Chest

Chest

Volume 130, Issue 4, October 2006, Pages 1096-1101
Journal home page for Chest

Original Research
Role of Gastroesophageal Reflux Symptoms in Exacerbations of COPD

https://doi.org/10.1378/chest.130.4.1096Get rights and content

Background and aims

The impact of gastroesophageal reflux disease (GERD) on exacerbations of COPD has never been evaluated. The aims of this investigation were to determine the prevalence of gastroesophageal reflux (GER) symptoms in COPD patients and the effect of GER on the rate of exacerbations of COPD per year.

Methods

A questionnaire-based, cross sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting criteria and agreeing to participate were asked to complete the Mayo Clinic GERD questionnaire by either personal/telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Other outcome measures noted were frequency and type of COPD exacerbations. Statistical analysis was performed using the Fisher exact test for categorical data and the independent t test for interval data.

Results

Eighty-six patients were enrolled and interviewed (mean age, 67.5 years). Male patients accounted for 55% of the study group. Overall, 37% of patients reported GER symptoms. The mean FEV1 percentage of predicted was similar in those with or without GER. The rate of exacerbations of COPD was twice as high in patients with GER symptoms compared to those without GER symptoms (3.2/yr vs 1.6/yr, p = 0.02).

Conclusions

The presence of GER symptoms appears to be associated with increased exacerbations of COPD.

Section snippets

Patients

From January 2003 through January 2004, 91 patients with a diagnosis of COPD were recruited from the pulmonary specialty clinics at the University of Florida Jacksonville. All patients with a diagnosis of COPD presenting to pulmonary clinic for routine health care during the study period were eligible for inclusion. Two investigators (I.R.A. and M.P.) attended pulmonary clinic sessions on a random basis determined monthly by other clinical responsibilities, and approached consecutive patients

Results

The patient demographics are shown in Table 1. Ninety-one patients participated in the investigation, 5 were unavailable for follow-up, and 1 was disqualified once for enrolling twice (Fig 1). The mean age was of 67 ± 8.3 years. Forty-eight patients (55%) were male. Thirty-two of the eligible surveyed patients (37%) were categorized as GERD(+) or having weekly symptomatic reflux over the past year. The groups were similar in gender, age, FEV1 percentage of predicted, continued smoking, body

Discussion

The aims of this study were as follows: (1) to demonstrate the prevalence of symptomatic GERD in our sampled population, and (2) to determine if there was an epidemiologic association between GER symptoms and exacerbations of COPD. The most significant finding in this study is that patients with the diagnosis of COPD and weekly GER symptoms have more acute exacerbations of COPD than patients with COPD without GER symptoms. We also found that in our sampled population, a prevalence of 36% of

Conclusions

We conclude that patients who have COPD and also have reflux symptoms at least once a week are more likely to have an increased number of COPD exacerbations when compared to COPD patients who are either asymptomatic or have GER symptoms less than once a week. This is true despite no significant difference in FEV1 percentage of predicted between the two groups. We also conclude that COPD patients with weekly GER symptoms and COPD are twice as likely to be hospitalized, have an ED visit, or

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    The authors have no significant conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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    Copyright © 2006 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.