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Evidence summaries

The Effect of Treatment for Gastro-Oesophageal Reflux on Asthma

Medical treatment for gastro-oesophageal reflux (GORD) may not reduce moderate to severe asthma exacerbations in adults with asthma and GORD, although it may result in slightly reduced use of rescue medications and small improvements in lung function measures. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results (wide confidence intervals).

Summary

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.

    References

    • 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):CD001496. [PubMed]

Primary/Secondary Keywords