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Uncertainty surrounds benefits of gastrooesophageal reflux disease treatment for asthma
Uncertainty surrounds benefits of gastrooesophageal reflux disease treatment for asthma
PEARLS No.
678
Clinical question
Is gastro-oesophageal reflux disease treatment effective in terms of its benefits for asthma in adults and children?
Bottom line
Some uncertainty surrounds the effectiveness of GORD treatment for people with asthma, particularly around outcomes of acute exacerbations and change in Asthma Quality of Life Questionnaire score.
However, some evidence suggests that pharmacological treatment with proton pump inhibitors, histamine H2 receptor antagonists or prokinetics for GORD may result in reduced use of asthma rescue medications, improved morning peak expiratory flow rate, and improved forced expiratory volume in 1 second.
The certainty of this evidence is currently moderate to low, and it is unlikely that the improvements seen are clinically significant.
Caveat
Most trials assessed participants with asthma across a range of spirometric severities, mainly from mild to moderate. Broad international recruitment was seen across these studies, with participants predominantly enrolled from the US, Europe, UK, India, Brazil, Chile, Iran and China. As a result, the outcomes of this review can be generalised to most people with asthma and GORD.
Evidence to support surgery for adults with asthma and GORD is currently lacking, as is evidence in the paediatric population.
Context
Asthma and GORD are common medical conditions that frequently coexist. GORD has been postulated as a trigger for asthma; however, evidence remains conflicting. Proposed mechanisms by which GORD could cause asthma include direct airway irritation from micro‐aspiration and vagally mediated oesophagobronchial reflux. However, a temporal association between the two does not establish that GORD triggers asthma; indeed, asthma might precipitate GORD.
Cochrane Systematic Review
Kopsaftis Z, Yap HS, Tin KS, et al. Pharmacological and surgical interventions for the treatment of gastro-oesophageal reflux in adults and children with asthma. Cochrane Database Syst Rev 2021;5(5):CD001496. This review contains 23 trials with a total of 2872 participants.
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