This week’s New England Journal has a great article examining the treatment of gastroesophageal reflux (GERD) in asthmatics. Previous studies have suggested a link between active reflux and active asthma. Recent studies looking at acid-reducing therapy in patients with both asthma and reflux have shown improvement in some measures of asthma control. Current asthma treatment guidelines suggest that in poorly controlled asthmatics, we should be looking for “silent reflux” as a potential cause for the poor control.
This study examined that recommendation by taking poorly controlled asthmatics without reflux symptoms and randomizing them to receive esomeprazole (Nexium) or placebo for 6 months. They also had subjects perform esophageal pH monitoring to assess for the presence of silent reflux.
The study has two important findings: 1) 40% of poorly controlled asthmatics have silent reflux. 2) Treating this with esomeprazole does absolutely nothing to improve asthma.
In a way this renders the further study of acid suppression and asthma useless. If patients are having active reflux, defined as symptoms two or more times a week, then they should receive acid reducing therapy on the basis of their reflux alone, regardless of their asthma status. The study also raises important questions about exactly how GERD makes asthma worse.
Please don’t take this to mean that you should run out and stop you reflux medications. If you have questions, discuss them with your doctors