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a Department of
Medicine, John Hunter Hospital, Locked Bag 1, Hunter Region Mail
Centre, NSW 2310, Australia, b Department of Respiratory and Sleep Medicine, c School of Paediatrics,
Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia
Correspondence to: Dr P G Gibson mdpgg{at}mail.newcastle.edu.au
Received 8 February 2000; Returned to authors 10 April 2000; Revised version received 14 October 2000; Accepted for publication 20 November 2000
BACKGROUND
A
systematic literature review was conducted to assess the effect of
treating reflux oesophagitis on asthma outcomes.
METHODSRandomised
controlled trials of reflux oesophagitis treatment in adults or
children that reported asthma health outcomes were included and
assessed in accordance with the standard Cochrane systematic review
process. Patients were typically adults with asthma and concurrent
symptomatic gastro-oesophageal reflux who received interventions that
included pharmacological therapy, conservative management, and surgery.
The following outcome measures were assessed: lung function, peak
expiratory flow, asthma symptoms, asthma medications, and nocturnal asthma.
RESULTSFrom 22 potentially relevant published and unpublished randomised controlled
trials, 12 were included. Treatment duration ranged from 1 week to 6 months. Eight trials reported that treatment improved at least one
asthma outcome, but these outcomes differed between trials. Overall,
treatment of reflux oesophagitis did not consistently improve forced
expiratory volume in one second (FEV1), peak expiratory
flow rate, asthma symptoms, nocturnal asthma symptoms, or use of asthma
medications in asthmatic subjects. Significant improvement in wheeze
was reported in two studies.
CONCLUSIONSThe
published literature does not consistently support treatment of reflux
oesophagitis as a means of controlling asthma. Further large randomised
controlled trials in subjects with a demonstrated temporal relationship
between gastro-oesophageal reflux and asthma are needed. These trials
should be conducted over at least 6 months to allow adequate time to
observe a treatment effect.
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