CHICAGO—The association between gastroesophageal reflux (GER) and asthma is well known, but a relationship between GER and chronic obstructive pulmonary disease (COPD) has not been established. New data indicate an increased prevalence of GER symptoms in COPD patients and suggest that the greater the degree of expiratory airflow limitation, the worse the GER symptoms may be.[1]

“There is good evidence that the proportion of patients with asthma … who experience significant gastroesophageal symptoms is much higher than in the general population,” Babak Mokhlesi, MD, told RESPIRATORY REVIEWS. “Based on that premise, we wanted to determine whether GER symptoms were more frequent in COPD patients than in the general population,” he added.

To investigate this issue, Dr. Mokhlesi and colleagues studied 100 veterans with COPD. All but one of the COPD patients were male. The control group consisted of 51 male internal medicine outpatients without COPD from the same medical center. GER symptoms were assessed via a self-reported questionnaire. Compared with control subjects, the patients with COPD had an increased prevalence (defined as the occurrence of symptoms once or more per week) of infrequent regurgitation (29% vs 10%), significant heartburn and/or regurgitation (19% vs 0%), dysphagia (17% vs 3%), and chronic cough (32% vs 9%).

INCREASED PREVALENCE OF GER IN COPD PATIENTS

Overall, 19 of the COPD patients had significant GER symptoms. “We were able to demonstrate that 19%—almost one in five—[of] COPD patients experienced significant heartburn and/or regurgitation at least once or more a week,” commented Dr. Mokhlesi, who is on staff at the Louis A. Weiss Memorial Hospital in Chicago. He added, “Our study shows that there is increased prevalence of GER in patients with COPD. However, it’s important to note that GER symptoms are not as common in COPD as they are in asthma.”

Spirometric and lung volume measurements were similar in the COPD patients with significant GER symptoms and in those without such symptoms. However, when the authors subdivided patients by lung function, they found that those who had a forced expiratory volume in one second (FEV1) of 50% or less than predicted were more likely to have significant GER symptoms than were those who had higher FEV1 results, suggesting a possible correlation between COPD severity and more frequent symptoms of GER.

DOES GER EXACERBATE COPD?

In addition, five of the 19 patients with significant GER symptoms reported increased respiratory symptoms (eg, cough, shortness of breath, or increased wheezing) in association with heartburn, acid regurgitation, or both. Four of the five patients noted increased use of ß2-agonist inhalers when they experienced reflux symptoms.

Noted Dr. Mokhlesi, “Both COPD and GER symptoms are common entities in the community.” But, whether having COPD predisposes patients to GER or vice versa remains to be proven.

In the meantime, Dr. Mokhlesi recommends, “Physicians should ask their patients with COPD if they have gastroesophageal reflux symptoms. If patients have GER symptoms once a week or more and they feel their respiratory symptoms are exacerbated by GER, it may be reasonable to prescribe a trial of antireflux therapy.”

—Deborah L. O’Connor