MII + PH PROBE AND CORRELATION WITH TRACHEAL PEPSIN ASPIRATES IN 6 PATIENTS WITH MODERATE TO SEVERE PERSISTENT ASTHMA

Abstract

Introduction: Coexistence of asthma, GER and mircroaspiration have been proposed previously. Non-acid reflux measures and availability of airway pepsin as markers of microaspiration have become recently available. We present the first series of cases from a retrospective chart review. Methods: Six patients (range 5 to 15 years) with moderate to severe asthma who had bronchoscopy as well as combined MII + pH probe studies (all greater then 18 hours) as part of their evaluations were reviewed. Pulmonary aspirates were assayed for pepsin. None had clinical suspicion of oral aspiration or radiological evidence of aspiration. One had history of TEF repair and one was subsequently diagnosed with a mild CF by genotype. All patients had impedance pH studies performed off acid suppression medications. NASPGHAN criteria for acid GER, number of MII episodes (up to the cervical esophagus) and symptom index for cough was recorded. Pepsin was assayed using floreroscein isothiocyanate casein. Normal airway aspirates are undetectable for pepsin. Results: All cases had positive airway pepsin (range 12.7 to 78 ng/ml). One case met criteria for acid GER. The 6 patients had mean of 42.5 (range 20 to 60) acid and non-acid MII episodes. Four of the six patients had minimal acid reflux events. There was a high degree correlation of MII with subsequent coughing events. Three of the five patients had symptoms index (SI) scores of greater then 40% for cough. Three of the four patients with high SI were mostly non-acid reflux events (range 57% to 100% nonacid MII events). Conclusion: Positive tracheal pepsin aspirates seen in these patients support microaspiration as a cause of chronic lung disease. Persistent asthma and MII events are associated temporally with cough. This supports GER and microapiration in association of moderate to severe asthma. Non-acid events in this sample were more commonly associated with symptoms, suggesting previous studies assessing acid GER only may be invalid.