ACAAI 2008: Gastroesophageal Reflux Disease Treatment Improves Asthma in Children

Jim Kling

November 11, 2008

November 11, 2008 (Seattle, Washington) — Treatment of gastroesophageal reflux disease (GERD) improves lung function in children with persistent asthma, according to a presentation here at the American College of Allergy, Asthma & Immunology 2008 Annual Meeting.

There is some evidence that GERD may provoke asthma, but it is not clear whether treating children with GERD improves asthma.

"In a select group of patients who are nonallergic, GERD is an important [factor] to consider in terms of therapy," lead investigator Aaron Kobernick, MD, MPH, from the Tulane University School of Medicine, in New Orleans, Louisiana, told Medscape Allergy & Clinical Immunology.

A total of 62 patients, aged 6 to 11 years, with nonatopic moderate to persistent asthma enrolled in the study. Using esophageal pH monitoring, Dr. Kobernick and colleagues identified 44 with abnormal results that suggested GERD. A total of 32 children were assigned to medical anti-GERD treatment (group A), 12 were assigned to surgical anti-GERD treatment (group B), and 18 continued regular anti-asthma treatment and acted as control subjects (group C). Researchers used spirometry to assess lung function before treatment and 2 years after treatment.

Anti-GERD treatment had a significant effect on the number of asthma exacerbations per patient per year. Patients who received treatment (groups A and B) had comparable numbers of exacerbations (0.61 and 0.78 respectively, P > .05). Those numbers were significantly lower than in group C (2.9, P < .05). An improvement in forced expiratory volume in the first second (FEV1) of at least a 20% was seen in 47% of children in group A, 58% of children in group B, and 28% of children in group C (P < .05 for group C vs groups A and B).

After 2 years of treatment, 22% of children in group A (medical treatment) showed a greater than 20% improvement in forced expiratory flow (FEF)25%-75%, 25% of children in group B (surgical treatment) showed a similar improvement, as did 11% of children in group C. FEF25%-75% in groups A and B was significantly higher than in group C (P < .05).

The study may have underestimated the number of patients who responded because many of the children had undergone extensive testing and treatment before enrollment. "Their lungs probably started looking a lot better before [they entered the study]," Dr. Kobernick said during his presentation.

The study "makes me think that if you have a child with a skin test that indicates no allergies, there's a good reason to try reflux medication," session moderator Timothy Craig, DO, professor of medicine and pediatrics at Penn State University, in Hershey, Pennsylvania, told Medscape Allergy & Clinical Immunology. He was not involved in the study.

The study did not receive commercial support. Dr. Kobernick and Dr. Craig have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2008 Annual Meeting: Abstract 1. Presented November 9, 2008.


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