Elsevier

Respiratory Medicine

Volume 109, Issue 9, September 2015, Pages 1147-1154
Respiratory Medicine

Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease

https://doi.org/10.1016/j.rmed.2015.06.009Get rights and content
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Highlights

  • Twenty-six percent of COPD patients report history of GORD.

  • Risk factors for GORD did not differ by sex despite higher prevalence in females.

  • Use of PPI/H2RA and self-reported GORD was associated with an increased risk of COPD.

  • The overall survival of COPD patients was not impacted by history of GORD or PPI/H2R treatment.

Abstract

Aim

To determine factors, overall and by sex, associated with self-reported gastro-oesophageal reflux disease (GORD) in chronic obstructive pulmonary disease (COPD) patients, and to evaluate relationships between GORD, its modification by acid suppression medications (Proton Pump Inhibitors [PPI]/histamine-2 receptor antagonists [H2RA]) and exacerbations of COPD and mortality.

Methods

Logistic regression was used to determine factors associated with GORD; Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for GORD and risk of exacerbation and death.

Results

Among 2135 COPD patients from the ECLIPSE cohort, 547 patients self-reported GORD, with female preponderance; 237 were taking PPI/H2RA. Risk factors for GORD did not differ by sex. When compared to patients who did not report GORD or use of PPI/H2RA, patients with GORD and taking PPI/H2RA had a significantly increased risk of exacerbation (HR = 1.58, 95%CI = 1.35–1.86); risk was also increased for patients reporting GORD only or PPI/H2RA use only (HR = 1.21 [1.04–1.40] and 1.33 [1.08–1.65], respectively). Similar findings were observed for risk of hospitalised exacerbation. GORD was not associated with mortality.

Conclusion

GORD in COPD patients is highly prevalent, and risk factors did not differ by sex. Use of PPI/H2RA and self-reported GORD were associated with increased risk of moderate-to-severe and hospitalised exacerbations.

Keywords

Chronic obstructive pulmonary disease
Cohort study
Epidemiology
Gastro-oesophageal reflux disease

Abbreviations

BODE
Body mass index, airflow Obstruction, Dyspnea and Exercise capacity
BMI
Body mass index
CES-D
Center for Epidemiologic Studies of Depression Scale
CI
Confidence interval
COPD
Chronic obstructive pulmonary disease
ECLIPSE
Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints
FACIT-F
Functional Assessment of Chronic Illness Therapy – Fatigue questionnaire
FEV1
Forced Expiratory Volume
FRC
Functional residual capacity
FVC
Forced Vital Capacity
GORD
Gastro-oesophageal reflux disease
H2RA
Histamine-2 receptor antagonist
HR
Hazard ratio
mMRC
modified Medical Research Council
NSAID
Non-steroidal anti-inflammatory drug
OR
Odds ratio
PPPY
Per person per year
PPI
Proton pump inhibitor
SD
Standard deviation
SGRQ-C
St.George's Respiratory Questionnaire for COPD patients
Rx
Treatment

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