Chest
Special ReportDoes Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux?: A Critical Review of the Literature
Section snippets
Materials and Methods
The MEDLINE database was used to identify studies published from 1966 to 1996 on the effects of medical antireflux therapy in asthma. The term asthma was combined with gastroesophageal reflux. Using the MEDLINE database, asthma was also combined with antacids, alginates, cimetidine, ranitidine, famotidine, nizatidine, cisapride, omeprazole, lansoprazole, pantoprazole, domperidone, and metoclopramide to insure that we identified all published English-language reports of medical antireflux
Results
A total of 242 papers were identified, 171 of which were published in English. Among these were 38 reviews, 15 editorials, and 20 letters. One letter reporting exacerbation of brittle asthma with cisapride32 and one report of a patient whose asthma improved with omeprazole after treatment with a combination of ranitidine and domperidone failed33 were not included in the analysis.
Surprisingly, only 12 studies of antireflux medication in asthmatics with GER have been published in the
Discussion
Is there a consensus among the antireflux studies?
Given the attention to the relationship between GER and asthma, it is surprising that there have been only 12 published, peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthma. Comparison of the different studies is difficult because their designs have been so different. Because these studies were done over a 15-year period, the asthma medications used, doses and duration of therapy, and both the
Conclusions
Despite the considerable literature dedicated to asthma and GER throughout the past 35 years, the nature of the relationship remains controversial. Clearly, there is a strong association between the two conditions. Regular symptomatic GER is four to five times more common in patients with asthma than in other patient groups.2 Abnormal GER, hiatal hernia, and esophagitis are also prevalent in asthma patients.3,4 Moreover, many asthmatics experience RARS and use their β-agonist inhalers during
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Supported by the Foothills Hospital Foundation and the Calgary Asthma Program.