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Abstract
Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.
Highlights
Asthma is a common chronic complex inflammatory airway disorder characterized by variable degrees of recurring symptoms of airflow obstruction and bronchial hyperresponsiveness [1]
The association between asthma and gastrooesophageal reflux (GER) has been debated for decades when Sir William Osler first observed the association between worsening asthma and distended stomach in 1892 [4]
The study design and the demographic data of patients and the control subjects as well as their clinical data are shown in Figure 1 and Table 1
Summary
Asthma is a common chronic complex inflammatory airway disorder characterized by variable degrees of recurring symptoms of airflow obstruction and bronchial hyperresponsiveness [1]. The majority of asthma patients can obtain the targeted level of control, some patients will not achieve control even with the best therapy [2]. The association between asthma and gastrooesophageal reflux (GER) has been debated for decades when Sir William Osler first observed the association between worsening asthma and distended stomach in 1892 [4]. Gastroesophageal reflux (GER) may cause chronic respiratory disease by vagal response and tracheal aspiration of gastric contents [6]. Aspiration of gastric contents changes pulmonary resistance and causes reactive airway obstruction [7]. Gastrooesophageal reflux may contribute to airway inflammatory events, possibly by sensory nerve stimulation and the subsequent release of tachykinins into the airway [8]
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