Treating Reflux Cuts Need for Asthma Drugs

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Study of children finds link between both disorders

By Gately

HealthScoutNews Reporter

TUESDAY, April 8 (HealthScoutNews) -- 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. , 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 ,

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, 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.

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.

Becki

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