Treating Reflux Cuts Need for Asthma Drugs

Study of children finds link between both disorders

TUESDAY, April 8, 2003 (HealthDayNews) -- What do severe acid reflux and asthma have in common?

Plenty, new research suggests, and the findings could play an important role in treating asthma in some children.

Treating acid reflux disease in children who had difficulty controlling their asthma more than halved their need for medications for the breathing disorder, the study says.

The findings appear in the April issue of Chest.

Researchers at West Jefferson Medical Center in New Orleans focused on 46 child asthma patients -- 27 with GERD, and 19 without the digestive disease -- who ranged from 5 to 11 years old.

During six months of observation before receiving GERD treatments, all the children used standard asthma medications: bronchodilators, which increase the diameter of air passages; inhaled corticosteroids; anti-inflammatory steroids; and leukotriene antagonists, which reduce the production or block the action of leukotrienes, substances released by cells in the lungs during an asthma attack, the researchers say.

The study excluded children with known risk factors for asthma such as allergies, a family history of asthma, premature birth, or a parent who smoked.

Of those children with GERD, 18 underwent treatment for a year with proton-pump inhibitors, which decrease the production of stomach acid, and changes in lifestyle. The other nine had surgical treatment that lets food and fluids pass into the stomach, but prevents them and stomach acid from returning to the esophagus and causing reflux.

The researchers, who measured asthma medication use in the six to 12 months after GERD treatment began, say the treatments dramatically reduced the need for asthma medications.

GERD treatments reduced overall need for asthma medications by more than 50 percent and inhaled corticosteroids by 89 percent, while eliminating the need for leukotriene antagonists.

Lead researcher Dr. Vikram Khoshoo says the findings clearly demonstrate GERD can play a role in inducing or exacerbating asthma in children, particularly among those with no known risk factors for the chronic inflammation of lung airways.

"In any child with difficult-to-control asthma, we should definitely look at GERD as a possible contributing factor," says Khoshoo, a pediatric gastroenterologist at West Jefferson Medical Center. "When we have optimal medication, good compliance and the best possible treatment, and we are still not able to make them symptom-free, we have to have a high suspicion that GERD is playing a role."

Previous research has estimated that at least half of children with asthma also have GERD, the study says. And Khoshoo says GERD likely contributes to asthma among kids with other known asthma risk factors.

Khoshoo says GERD might contribute to asthma in a few different ways: A small amount of acid from the stomach could enter the lungs, leading to inflammation in the lungs and constriction of the airways. And acid from the stomach could also irritate the lining of the esophagus, leading to constriction of the airways.

The different types of GERD treatment -- medications and lifestyle changes or surgery -- yielded similar reductions in the need for asthma medications, Khoshoo says.

Dr. Linda Cox, a fellow of the American Academy of Allergy, Asthma and Immunology, called the study's findings "very important."

"I think what it highlights is that if you are looking at a non-allergic group of asthmatics -- the minority in pediatric asthma -- then you need to look for a driving force or underlying cause" of the asthma, says Cox, who treats asthma at her private practice in Fort Lauderdale, Fla.

For patients who do not have documented allergic diseases or asthma in their family history, she says, the findings "would push in the direction of looking for reflux."

But, Cox adds, excluding from the study children with allergic diseases eliminates most of those with asthma, which experts say afflicts more than 4.8 million Americans under 18.

"Your real-life situation is a majority of children with asthma you're going to see are probably going to have allergic factors playing a role," she says.

Cox says she would like to see further research into the possible role of GERD in children with other known risk factors for asthma.

More information

For more on asthma and GERD, visit the American Academy of Allergy, Asthma and Immunology. To learn more about asthma, check with the Mayo Clinic.

SOURCES: Vikram Khoshoo, M.D., Ph.D., pediatric gastroenterologist, West Jefferson Medical Center, New Orleans; Linda Cox, M.D., physician, Fort Lauderdale, Fla., and fellow, American Academy of Allergy, Asthma and Immunology, Milwaukee; April 2003 Chest
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