Anti-reflux medications for people with GORD amd asthma



A team of authors based in Australia updated the Cochrane Review on Pharmacological and surgical interventions for the treatment of gastro‐oesophageal reflux in adults and children with asthma. Lead author Zoe Kopsaftis said "People with asthma often experience symptoms of gastro-oesophageal reflux disease (GORD), which may prompt an exacerbation. So, is there any benefit in treating GORD in people with asthma? This updated review adds new evidence to underpin use of anti-reflux medications in adults with asthma. We found that use of anti-reflux medications, in people with asthma and GORD, can improve lung function and reduce the need to use asthma rescue medications. Evidence to support surgery for people with asthma and GORD is currently lacking, as is evidence for treatment in children."

Read the full review here.
The plain language summary is below.


Treatment of gastro‐oesophageal reflux disease to help manage asthma in adults and children


Background

People with asthma are three times more likely to have reflux (where acid from the stomach comes back up the oesophagus) than healthy people. Reflux may be a trigger for asthma, or alternatively, asthma may trigger reflux. Treatments that can help reflux include drugs that reduce stomach acids or improve stomach emptying. Research studies have found inconsistent benefit for improvement in asthma symptoms or lung function. Although asthma may be improved in some people, it was not possible to predict who might benefit.


Review question

This review aimed to investigate if treatment for gastro‐oesophageal reflux disease (GORD) would benefit adults and children with asthma.

Study characteristics

To answer this question, we looked for all randomised controlled trials (RCTs) comparing GORD treatment (medical and/or surgical intervention) to placebo or no treatment in adults or children who had been diagnosed as having both asthma and GORD.


Key results

We found 23 studies for inclusion in this review. These studies focused mostly on adults, with a total of 2872 participants involved. Only two studies assessed the effects of treating GORD in children, and two investigated the benefits of using surgery for GORD to improve asthma control. According to evidence presented in this review, using medication to treat GORD in people with asthma probably reduces the amount of rescue medication needed to control asthma symptoms and also probably improves lung function to a small degree. It is important to note that these benefits may be too small to make an impact on the daily life of someone with asthma.

Based on available evidence, this review is not able to show if there was clear benefit of treatment for asthma symptoms for quality of life, or how many flare‐ups are experienced by a person with asthma. Because researchers used many different approaches to treating people who participated in their studies, it is also difficult to suggest whether a specific type of medication regimen would be best. Not many of the included studies mentioned negative effects of being involved in the research. Those that did reported that any negative effects during the research period happened equally in both treatment and placebo/no treatment groups.

We did not find any data in the included studies related to hospital admissions nor to emergency room or unscheduled doctor visits.


Certainty of evidence

Overall certainty of the evidence was assessed as moderate to low. This is mainly because the studies that were included in this review were very different in the way they approached the research, which produced variable results.

Bottom line

Moderate‐certainty evidence (as some of the included studies were poorly described) shows that with medical treatment for GORD, people with asthma may experience a small improvement in their lung function and may be able to reduce their need to use rescue medications. However, the impact of treatment for GORD on events such as asthma flare‐ups, symptoms, or the need to go to the hospital or consult a doctor is uncertain. Additionally, there was not enough evidence, with only two studies reporting on each, to assess surgical treatment or the effectiveness of GORD treatment in children.