Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children
Introduction
Pediatric laryngopharyngeal reflux (LPR) has gained better recognition over the past few years. Even though the relationship between gastro-esophageal reflux disease (GERD) and asthma has been investigated, there was a little data about the association between asthma and laryngopharyngeal reflux (LPR) in children [1].
The relationship between reflux and respiratory distress resembles chicken or egg dilemma. There is no doubt that reflux of gastric contents is an important cause of chronic cough [2]. It was speculated that refluxate may enter the airway and stimulate tracheo-bronchial cough receptors and it is possible that microaspirations occur directly stimulating cough and/or resulting in airway inflammation and cough reflex sensitization [3]. Lung hyperinflation in asthma lowers the diaphragm and can interfere with the flap valve mechanism produced by the angulated entry of the esophagus into the stomach. These fluctuations in intrathoracic and intraabdominal pressures increase the risk of reflux [4].
Laryngopharyngeal reflux is different from classic gastroesophageal reflux. It is believed that the primary defect in LPR might be upper esophageal sphincter dysfunction, whereas GER is lower esophageal dysfunction [5]. Patients with LPR usually deny symptoms of heartburn and regurgitation. Instead of gastrointestinal symptoms, most LPR patients have throat symptoms like dysphonia, chronic cough, globus pharyngeus, and chronic throat clearing [6].
A diagnosis of LPR may be established by questioning of the symptoms, videolaryngoscopic evaluation of larynx or double probe pH monitoring [7], [8], [9]. Ambulatory 24 h double probe (pharyngeal and esophageal) pH monitoring is both highly sensitive and specific for diagnosis of LPR [10], [11].
The aim of this study was to determine the predictive value of reflux symptom score and LPR disease index to diagnose LPR and GER in children with asthma by comparing the results of double probe pH monitoring study. Secondly we aimed to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence.
Section snippets
Subjects and methods
A total of 50 patients aged 7–17 years (23 girls, 27 boys) with mild to moderate persistent asthma, between December 2009 and December 2010 were randomly included in this study according to controlled and uncontrolled status at asthma outpatient clinic. Randomization was performed using a computer generated randomization list and 50 patients were selected out of 150 patients with asthma. However, 4 patients did not enter the study because the procedure was invasive. Three of these 4 patients
Results
Fifty laryngoscopic and pH monitoring studies were completed without any complications. Demographic and baseline characteristics of the patients according to the asthma control status are summarized in Table 1.
Eighty percent (40/50) of the study population had significant acid reflux documented by either the esophageal or the pharyngeal probe. Of those, seventy percent (35/50) of the patients had abnormal reflux documented by the pharyngeal probe, and forty-six percent (23/50) of the patients
Discussion
The study was designed especially with the aim of evaluating the impact of LPR-GER on asthma control status and determining the predictive value of symptoms and laryngeal findings to diagnose LPR. Currently, the gold standard to diagnose LPR is the 24-h dual probe pH meter study but it can be done only by a specialist without anesthesia and young children might need to be hospitalized for 24 h to prevent them from pulling the tube out. In addition after the replacement of probes, X-ray is
Acknowledgments
This study was supported by the Commission of Scientific Research Projects of Ondokuz Mayis University (Project No: PYO.TIP.1904.09.043) and it was presented in 30th Congress of the European Academy of Allergy and Clinical Immunology, 2011.
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