Effects of Proton Pump Inhibitors in Asthmatics with Gastroesophageal Reflux Disease

Yun Bin Lee; Joo Hyun Lim; Yoon Jin Choi; Ji Yeon Kim; Jun Hyuk Son; Sun Mi Choi; Hyun Jin Jo; Cheol Min Shin; Sang Hyup Lee; Young Soo Park; Jin-Hyeok Hwang; Jin-Wook Kim; Sook-Hyang Jeong; Nayoung Kim; Dong Ho Lee; Hyun Chae Jung; In Sung Song

doi:10.4166/kjg.2011.58.4.178

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Lee, Lim, Choi, Kim, Son, Choi, Jo, Shin, Lee, Park, Hwang, Kim, Jeong, Kim, Lee, Jung, and Song: Effects of Proton Pump Inhibitors in Asthmatics with Gastroesophageal Reflux Disease

Original Article

Korean J Gastroenterol 2011;58(4):178-183.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.4.178

Effects of Proton Pump Inhibitors in Asthmatics with Gastroesophageal Reflux Disease

Yun Bin Lee¹, Joo Hyun Lim¹, Yoon Jin Choi¹, Ji Yeon Kim¹, Jun Hyuk Son¹, Sun Mi Choi¹, Hyun Jin Jo^1,², Cheol Min Shin^1,², Sang Hyup Lee^1,², Young Soo Park^1,², Jin-Hyeok Hwang^1,², Jin-Wook Kim^1,², Sook-Hyang Jeong^1,², Nayoung Kim^1,², Dong Ho Lee^1,², Hyun Chae Jung¹, In Sung Song¹

¹Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

²Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to: Dong Ho Lee, Department of Internal Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-7006, Fax: +82-31-787-4051, E-mail: dhljohn@snubh.org

Received 20 April 2011 Accepted 13 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Gastroesophageal reflux disease (GERD) is common in asthma patients. Proton pump inhibitor (PPI) therapy improves symptoms of asthma in some patients. The objective of this study was to investigate endoscopic findings of GERD in asthma patients and to assess the effect of gastric acid suppression with the PPIs on symptom improvement and pulmonary function.

Methods

From 105 consecutive patients with GERD symptoms during follow up for asthma, 45 patients were enrolled. Patients enrolled to this study were asked about GERD symptoms before and after treating with PPI. Endoscopic findings were described according to Los Angeles classification. The improvement of asthma symptoms and follow-up pulmonary function test were investigated after administration of PPIs.

Results

Esophageal symptoms such as heartburn and acid reflux were present in 25 patients (55.6%), and patients without esophageal symptoms were 20 (44.4%). The degree of endoscopic abnormality was not significantly different between groups with or without esophageal symptoms. The improvement of symptoms was seen in 44 patients (97.8%) except 1 patient after administration of PPIs. The number of patients classified to the low-dose group was 7 patients (15.6%) and that of patients classified to the standard-dose group was 38 patients (84.4%). The follow-up pulmonary function test, peak expiratory flow rate (L/sec) was improved in 3 patients (3 of 7, 42.9%) of the low-dose group, and in 24 patients (24 of 38, 63.2%) of the standard-dose group. The improvement of ventilatory function was not significantly different according to dose of PPIs.

Conclusions

Treatment with PPIs is expected to improve subjective symptoms and ventilatory function in asthma patients.

Keywords: Asthma, Gastroesophageal reflux, Proton pump inhibitors, Peak expiratory flow rate

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Table 1.

Demographic Data of 45 Asthmatic Patients with o without Esophageal Symptoms

	Esophageal symptom		p-value
	Yes (n=25)	No (n=20)	p-value
Age	53.56±13.91	58.05±15.58	0.313
Male/Female	7/18	4/16	0.883 ^a
FEV₁ (% predicted)	88.52±24.17	82.5±20.71	0.382
PEF (L/sec)	5.5±1.81	4.89±1.78	0.263
Asthma medication
ICS	19	19	0.112
LABA	19	16	1.000
PPI treatment duration (wk)	10.44±6.87	10.6±8.56	0.945

Values are presented as number or mean±SD.

FEV₁, forced expiratory volume in one second; PEF, peak expira tory flow rate; ICS, inhaled glucocorticosteroid; LABA, long-acting β₂-agonist; PPI, proton pump inhibitor.

^a chi square test.

Table 2.

Endoscopic Finding of Patients with or without Esophageal Symptoms

	Esophageal symptom		Total
	Yes	No	Total
Endoscopic finding
Normal	7 (28.0)	2 (10.0)	9 (20.0)
Minimal change	17 (68.0)	15 (75.0)	32 (71.1)
LA-A^a	0 (0.0)	2 (10.0)	2 (4.4)
LA-B^a	1 (4.0)	1 (5.0)	2 (4.4)
Total	25	20	45

Values are presented as number (%).

p=0.196, Fisher's exact test.

^a Los Angeles classification.

Table 3.

Effect of Therapy on PFT in Patients with or withou Esophageal Symptoms

	Esophageal symptom		Total
	Yes	No	Total
PFT Improved	15 (60.0)	12 (60.0)	27 (60.0)
Stationary/aggravated	10 (40.0)	8 (40.0)	18 (40.0)
Total	25	20	45

Values are presented as number (%).

PFT, pulmonary function test.

p=1.000, chi square test.

Table 4.

Effect of Therapy on PFT according to PPI Dose

	PPI dose		Total
	Low	Standard	Total
PFT Improved	3 (42.9)	24 (63.2)	27 (60.0)
Stationary/aggravated	4 (57.1)	14 (36.8)	18 (40.0)
Total	7	38	45

Values are presented as number (%).

PPI, proton pump inhibitor; PFT, pulmonary function test.

p=0.412, Fisher's exact test.

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ORCID iDs: Nayoung Kim
https://orcid.org/http://orcid.org/0000-0002-9397-0406
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