Laryngopharyngeal reflux is prevalent in patients with chronic obstructive pulmonary disease

Abstract

Introduction: There are no objective data regarding the impact of laryngopharyngeal reflux (LPR) on chronic obstructive pulmonary disease (COPD) and COPD outcomes. We hypothesize that LPR, even if silent, may be a contributing factor for the prognosis of, and clinical outcomes of COPD. Methods: 203 subjects were separated into 3 groups: 107 ambulatory patients with COPD and no other respiratory illnesses (COPD_1); 86 hospitalized patients with COPD in addition to other respiratory illnesses (COPD_2) and 11 healthy controls. RYAN score was used to evaluate the presence of LPR. RYAN score ≥ 9.4 (pH Results: 18% of the controls had pathologic RYAN score (i.e. LPR) compared to 67% of the COPD_1 patients (OR=9.26; p=0.006) and 58% of the COPD_2 patients (OR=6.25; p=0.024). Patients in the COPD_1 group had a significantly higher RYAN score than the COPD_2 group (234 vs. 147 p= 0.018) and healthy controls (234 vs. 25; p=0.002). Overall, having COPD significantly increased the risk of having an abnormal RYAN score (or LPR) even after adjusting for age (OR=5.604; p=0.035). There was a significant decrease in RYAN Score after only 1 month proton pump inhibitor (PPI) therapy (458 vs 309; p= 0.047). There was no association between RYAN score and BODE index, exacerbation and severe exacerbation rate, Leicester questionnaire or the Belafsky (RSI) questionnaire. Conclusion: Laryngopharyngeal reflux cannot be diagnosed from symptoms only, is more common in patients with COPD, and can be reduced by PPI therapy.