The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results (wide confidence intervals).
A Cochrane review [Abstract] 1 included 23 studies with a total of 2 872 subjects (predominantly adults) with moderate to severe asthma and a diagnosis of gastro-oesophageal reflux disease (GORD). Only 2 studies assessed effects of intervention on children. Interventions included proton pump inhibitors (12 studies), histamine H2 receptor antagonists (5), combination drug therapy (4), surgery (2), and non-pharmacological conservative anti-reflux therapy (1).
There was no statistically significant difference in the number of participants experiencing one or more moderate/severe asthma exacerbations with medical treatment for GORD (OR 0.53, 95% CI 0.17 to 1.63; 2 studies, n=1 168). None of the included studies reported data on hospital admissions, emergency department visits, and unscheduled doctor visits.Medical treatment improved forced expiratory volume in one second (FEV1) by a small amount (MD 0.10 L, 95% CI 0.05 to 0.15; 7 studies, n=1 333) and reduced use of rescue medications (MD -0.71 puffs per day, 95% CI -1.20 to -0.22; 2 studies, n=239). GORD treatment improved morning peak expiratory flow rate (MD 6.02 L/min, 95% CI 0.56 to 11.47; 5 studies, n=1 262), but the result was uncertain. These mean improvements did not reach clinical importance.
Note: Evidence to support surgery for adults with asthma and GORD is currently lacking, as is evidence in the paediatric population.
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