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. 2000;2003(2):CD001496.
doi: 10.1002/14651858.CD001496.

Gastro-oesophageal reflux treatment for asthma in adults and children

P G Gibson  1 , R L Henry, J L Coughlan
Affiliations

Gastro-oesophageal reflux treatment for asthma in adults and children

P G Gibson et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: Asthma and gastro-oesophageal reflux are both common medical conditions and often co-exist. Studies have shown conflicting results concerning the effects of lower oesophageal acidification as a trigger of asthma. Furthermore, asthma might precipitate gastro-oesophageal reflux. Thus a temporal association between the two does not establish that gastro-oesophageal reflux triggers asthma. Randomised trials of a number of treatments for gastro-oesophageal reflux in asthma have been conducted, with conflicting results.

Objectives: The objective of this review was to evaluate the effectiveness of treatments for gastro-oesophageal reflux in terms of their benefit on asthma.

Search strategy: The Cochrane Airways Group trials register, review articles and reference lists of articles were searched.

Selection criteria: Randomised controlled trials of treatment for oesophageal reflux in adults and children with a diagnosis of both asthma and gastro-oesophageal reflux.

Data collection and analysis: Trial quality and data extraction were carried out by two independent reviewers. Authors were contacted for confirmation or more data.

Main results: Nine trials met the inclusion criteria. Interventions included proton pump inhibitors (n=3), histamine antagonists (n=5), surgery (n=1) and conservative management (n=1). Treatment duration ranged from 1 week to 6 months. A temporal association between asthma and gastro-oesophageal reflux was investigated in 4 trials and found to be present in a proportion of participants in these trials. Anti-reflux treatment did not consistently improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications.

Reviewer's conclusions: In asthmatic subjects with gastro-oesophageal reflux, (but who were not recruited specifically on the basis of reflux-associated respiratory symptoms), there was no overall improvement in asthma following treatment for gastro-oesophageal reflux. Subgroups of patients may gain benefit, but it appears difficult to predict responders.

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Conflict of interest statement

NIL

Figures

1.1
1.1. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 1 Morning Peak Expiratory Flow.
1.2
1.2. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 2 Evening Peak Expiratory Flow.
1.3
1.3. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 3 Nocturnal Symptoms Score.
1.4
1.4. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 4 B2 Use Puffs per Day.
1.5
1.5. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 5 Methacholine Challenge (PC20).
1.6
1.6. Analysis
Comparison 1 Medical Therapy of GOR vs Placebo, Outcome 6 Improvement in wheezing.
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References

References to studies included in this review

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