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P241  Anti-Reflux Surgery Conveys a Long Term Improvement in Respiratory Symptoms in Asthma and Chronic Cough
  1. KE Cusworth,
  2. CA Lynch,
  3. S Ejiofor,
  4. R Sathyamurthy,
  5. P Super,
  6. C Noble,
  7. AH Mansur
  1. Birmingham Heartlands Hospital, Birmingham, UK


Introduction Previously we have reported short term improvement in asthma related quality of life (AQLQ) and cough scores following anti-reflux surgery in asthma and chronic cough patients with gastro-oesophageal reflux disease (GORD) that did not respond to medical treatment. Herein we report on long-term outcome data.

Method A database of respiratory patients undergoing anti-reflux surgery was set up to assess GORD and respiratory symptoms at baseline, 3 months and long-term (mean 5 years). Data on lung function was also collected.

Results Twenty-eight patients (71% female, mean age = 50.1 years) completed an AQLQ (13 asthmatics) or cough score questionnaire (15 chronic cough patients) at a mean of 66 months following surgery (range = 6–100 months). The Hull reflux cough questionnaire (HRCQ) was also completed. All had significant reflux at baseline confirmed with oesophageal manometry and pH studies (mean DeMeester score of 47.26 [normal < 14.72], mean lower oesophageal sphincter pressure of 4.6mmHg [normal = 12–25] and a mean reflux time of 11.7% [normal < 4%]). The mean baseline FEV1 in the asthma group was 2.22 L (76% predicted) with a mean FEV1/FVC of 74%. In the cough group, mean FEV1 at baseline was 2.45 L (90% predicted) with a mean FEV1/FVC of 84%.

In the asthma group there was significant improvement in mean AQLQ (7 = best, 0 = worst) from baseline of 3.29 (SD=1.1) to 4.38 (SD=1.2) at 3 months and 4.44 (SD=1.4) long term (Figure 1). In the cough group, cough scores (0 = no cough and 10 = worst cough) significantly improved from a baseline mean of 7.3 (SD=1.9) to 2.6 (SD=3) at 3 months and 3.9 (SD=3.1) long term (Figure 1). In the asthma group we also observed an improvement in the mean HRCQ (0 = no reflux, 70 = worst reflux) from 49.2 (SD 13.8) at baseline to 22 (SD 13.9) long-term, without corresponding improvement in FEV1.

Conclusion Anti-reflux surgery provides sustainable long-term benefit to patients with significant GORD and poorly controlled asthma or chronic cough. These data require further confirmation in controlled trials.

Abstract P241 Figure 1

(A) Longterm effect of antireflux surgery on cough score, (B) Longterm effect of anti-reflux surgery on AQLQ

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