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Lang JE. Contribution of comorbidities to obesity-related asthma in children. Paediatr Respir Rev 2021; 37:22-29. [PMID: 32828671 DOI: 10.1016/j.prrv.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 01/21/2023]
Abstract
Children with obesity are at increased risk for developing asthma that is difficult to control. A complicating factor to asthma management among these children is likely the commonplace co-morbidities that also result from obesity. We discuss three common obesity-related comorbidities which appear to complicate the effective management of asthma, including hypovitaminosis D, obstructive sleep apnea and gastro-esophageal reflux. Each conditions requires more research to understand their effects on asthma management.
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Affiliation(s)
- J E Lang
- Duke University School of Medicine, Duke Clinical Research Institute, 301 West Morgan Street, Durham, NC 27701, USA.
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2
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Vazquez Garcia G, Blake K. Considerations for the Child with Nonatopic Asthma. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2020; 33:39-42. [PMID: 33406019 DOI: 10.1089/ped.2019.1104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Asthma guidelines provide clinicians with evidence-based management strategies for this chronic condition. The preferred therapy for patient with persistent asthma is inhaled corticosteroids. However, ∼40% of the patients with persistent asthma continue to present with symptoms while treated according to the guidelines. Multiple factors are being explored to explain the variability in response to inhaled corticosteroids including asthma phenotype and genetic predisposition among others. The nonatopic asthma phenotype has been described in the literature. These patients tend to have milder symptoms of asthma and typically outgrow their asthma by adolescence. They present with chronic asthma symptoms in the absence of a positive allergy test, either skin prick test or specific immunoglobulin E blood test. Although patients with nonatopic asthma share many characteristics with patients with atopic asthma, there are several studies that suggest a different inflammatory pathway may be involved in their pathophysiology. Therefore, it is possible that children with nonatopic asthma could respond differently to inhaled corticosteroids compared with those with atopic asthma. Currently there is a variable definition of this phenotype. Furthermore, there is a paucity of therapeutic trial directed toward the patients with nonatopic asthma specifically. Future research should be guided toward identifying the inflammatory pathways in nonatopic asthma and potential phenotype-guided therapies.
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Affiliation(s)
| | - Kathryn Blake
- Division of Pulmonology, Nemours Children's Specialty Care, Jacksonville, Florida
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3
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Lechien JR, Mouawad F, Mortuaire G, Remacle M, Bobin F, Huet K, Nacci A, Barillari MR, Crevier-Buchman L, Hans S, Finck C, Akst LM, Karkos PD. Awareness of European Otolaryngologists and General Practitioners Toward Laryngopharyngeal Reflux. Ann Otol Rhinol Laryngol 2019; 128:1030-1040. [PMID: 31257901 DOI: 10.1177/0003489419858090] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the current trends in management of laryngopharyngeal reflux (LPR) among young European otolaryngologists and general practitioners (GP). METHODS An international survey was sent to European general practitioners and all otolaryngologists under 45 years old from the 2017 IFOS meeting. This survey was conducted by the LPR Study Group of YO-IFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies). RESULTS Among the 2500 attendees, 230 European otolaryngologists (response rate = 9%) completed the survey; an additional 70 GPs also completed the survey. GPs did not differentiate between gastroeosophageal reflux disease (GERD) and LPR, overstating GERD-related symptoms (ie, heartburn and regurgitations) in LPR clinical presentation and relying on gastrointestinal endoscopy for LPR diagnosis. Otolaryngologists also believe that GERD-related symptoms are prevalent in LPR. Knowledge of nonacid and mixed LPR and use of multichannel intraluminal impedance-pH monitoring are still limited in both groups. A therapeutic dichotomy exists between groups: GPs mainly use a 4-week once daily empiric proton pump inhibitors (PPIs) trial, while otolaryngologists use PPIs twice daily for a longer therapeutic period ranging from 8 to 12 weeks. More than 50% of GPs and otolaryngologists believe that they are not adequately knowledgeable and skilled about LPR. CONCLUSION The majority of GPs and otolaryngologists do not believe themselves to be sufficiently informed about LPR, leading to different practice patterns and grey areas. The elaboration of international recommendations in the management of reflux is needed to improve practices.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Francois Mouawad
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Université de Lille, Lille, France
| | - Geoffrey Mortuaire
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Lille, Université de Lille, Lille, France
| | - Marc Remacle
- Department of Otorhinolaryngology and Head and Neck Surgery, CH Luxembourg, Lille, Luxembourg
| | - Francois Bobin
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otorhinolaryngology and Head and Neck Surgery, Polyclinique de Poitiers, Poitiers, France
| | - Kathy Huet
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Petros D Karkos
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology-Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
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Tang M, Blake KV, Lima JJ, Mougey EB, Franciosi J, Schmidt S, Hossain MJ, Cobbaert M, Fischer BM, Lang JE. Genotype tailored treatment of mild symptomatic acid reflux in children with uncontrolled asthma (GenARA): Rationale and methods. Contemp Clin Trials 2019; 78:27-33. [PMID: 30659924 PMCID: PMC7039713 DOI: 10.1016/j.cct.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
Asthma causes enormous suffering and cost for children in the US and around the world [1-3]. Co-morbid gastroesophageal reflux disease (GERD) makes asthma management more difficult due to increased symptoms. Proton pump inhibitor (PPI) drugs are effective at improving to GERD symptoms, however they have demonstrated only modest and variable effects on asthma control in the setting of co-morbid GERD. Importantly, PPI metabolism and efficacy depend on CYP2C19 genotype. The Genotype Tailored Treatment of Symptomatic Acid Reflux in Children with Uncontrolled Asthma (GenARA) study is a randomized, double-blind, placebo-controlled trial to determine if genotype-tailored PPI dosing improves asthma symptoms among children with inadequately controlled asthma and GERD symptoms. This study has an innovative design to both assess the efficacy of genotype-tailored PPI dosing and perform pharmacokinetic modeling of the oral PPI Lansoprazole. Children ages 6-17 years old with clinician-diagnosed asthma and mild GERD symptoms will submit a saliva sample for CYP2C19 genotyping. Participants will undergo a two-step randomization to: (1) genotype-tailored versus conventional dosing of open-label oral lansoprazole for pharmacokinetic modeling, and (2) genotype-tailored lansoprazole daily versus placebo for 24 weeks to determine the effect of genotype-tailored PPI dosing on asthma control. Measures of asthma control, spirometry, and nasal washes during acute illnesses will be collected at 8-week intervals throughout the study. GenARA will better define the effects of CYP2C19 genotype on the dose response of lansoprazole in children and adolescents and assess if a novel dosing regimen improves GERD and asthma control.
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Affiliation(s)
- Monica Tang
- Division of Allergy/Immunology and Pulmonary Medicine, Duke University School of Medicine, Duke Children's Hospital and Health Center, Durham, NC, United States
| | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, FL, United States
| | - John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, FL, United States
| | - Edward B Mougey
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, FL, United States
| | - James Franciosi
- Department of Pediatrics, Nemours Children's Hospital, Nemours Children's Health System, Orlando, FL, United States
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, United States
| | - Md Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
| | - Marjan Cobbaert
- Department of Pharmacometrics, Duke Clinical Research Institute, Durham, NC, United States
| | - Bernard M Fischer
- Division of Allergy/Immunology and Pulmonary Medicine, Duke University School of Medicine, Duke Children's Hospital and Health Center, Durham, NC, United States
| | - Jason E Lang
- Division of Allergy/Immunology and Pulmonary Medicine, Duke University School of Medicine, Duke Children's Hospital and Health Center, Durham, NC, United States.
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Min YZ, Subbarao P, Narang I. The Bidirectional Relationship Between Asthma and Obstructive Sleep Apnea: Which Came First? J Pediatr 2016; 176:10-6. [PMID: 27318377 DOI: 10.1016/j.jpeds.2016.05.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/11/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Yap Zhi Min
- Department of Pediatrics, University Children's Medical Institute, National University Health System, Singapore
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Ioan I, Poussel M, Coutier L, Plevkova J, Poliacek I, Bolser DC, Davenport PW, Derelle J, Hanacek J, Tatar M, Marchal F, Schweitzer C, Fontana G, Varechova S. What is chronic cough in children? Front Physiol 2014; 5:322. [PMID: 25221517 PMCID: PMC4148026 DOI: 10.3389/fphys.2014.00322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/05/2014] [Indexed: 01/28/2023] Open
Abstract
The cough reflex is modulated throughout growth and development. Cough—but not expiration reflex—appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient toward specific etiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, pediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific.
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Affiliation(s)
- Iulia Ioan
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Mathias Poussel
- Service Des Examens de la Fonction Respiratoire et de L'aptitude à L'exercice Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Laurianne Coutier
- EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Ivan Poliacek
- Institute of Medical Biophysics, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Donald C Bolser
- Department of Physiological Sciences, University of Florida Gainesville, FL, USA
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida Gainesville, FL, USA
| | - Jocelyne Derelle
- Service de Médecine Infantile et de Génétique Clinique, Hôpital D'enfants Vandœuvre-lès-Nancy, France
| | - Jan Hanacek
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Milos Tatar
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - François Marchal
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Cyril Schweitzer
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France ; Service de Médecine Infantile et de Génétique Clinique, Hôpital D'enfants Vandœuvre-lès-Nancy, France
| | - Giovanni Fontana
- Department of Internal Medicine, University of Florence Florence, Italy
| | - Silvia Varechova
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
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7
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A preliminary investigation of anti-reflux intervention for gastroesophageal reflux related childhood-to-adult persistent asthma. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2014; 8:3. [PMID: 24987453 PMCID: PMC4077581 DOI: 10.1186/1750-1164-8-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Childhood-to-adult persistent asthma is usually considered to be an atopic disease. However gastroesophageal reflux may also play an important role in this phenotype of asthma, especially when it is refractory to pulmonary medicine. METHODS Fifty-seven consecutive GERD patients who had decades of childhood-to-adult persistent asthmatic symptoms refractory to pulmonary medication were enrolled. GERD was assessed by a symptom questionnaire, endoscopy, reflux monitoring, and manometry, and treated by Stretta radiofrequency (SRF) or laparoscopic Nissen fundoplication (LNF). The outcomes were followed up with a questionnaire for an average of 3.3 ± 1.1 years. RESULTS Upper esophageal sphincter hypotonia, lower esophageal sphincter (LES) hypotonia, shortened LES, and esophageal body dyskinesia were demonstrated by esophagus manometry in 50.9%, 43.9%, 35.1%, and 45.6% of the patients, respectively. The symptom scores for heartburn, regurgitation, coughing, wheezing, and chest tightness significantly decreased from 5.8 ± 2.0, 5.6 ± 2.0, 7.3 ± 1.6, 8.4 ± 1.2, and 8.1 ± 1.5, to 1.2 ± 1.8, 1.1 ± 1.6, 2.8 ± 2.5, 3.8 ± 2.7, and 3.9 ± 2.7, respectively, after anti-reflux treatment (P < 0.001). CONCLUSIONS Esophagus dysfunction is high in childhood-to-adult persistent asthmatic patients with GERD. SRF and LNF are both effective for esophagus symptoms as well as persistent asthmatic symptoms for these patients. GER may relate with asthmatic symptoms in some patients. Evaluating asthmatic patients for possible treatment of the underlying cause, such as GERD, may improve symptoms and prevent disease persistence.
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Abstract
PURPOSE OF REVIEW Gastroesophageal reflux disease (GERD) is common in children with asthma and may be present with or without symptoms. Clinicians, influenced by position statements in national guidelines, have routinely treated children with poorly controlled asthma with various anti-GERD medications. This practice is based on the pervasive but unproven belief that GERD is an important determinant of poor asthma control. RECENT FINDINGS Clinical studies show that GERD is highly prevalent in children with asthma, with estimates as high as 80%, but nearly half of the children are asymptomatic. However, there is no conclusive evidence per se that asymptomatic GERD informs asthma control, and treatment of GERD in the few controlled trials available for review does not substantively improve asthma outcomes. In a recent large controlled clinical trial, treatment with a proton-pump inhibitor (PPI) was not only ineffective, but adverse effects were common, including an increased prevalence of symptomatic respiratory infections. SUMMARY Current evidence does not support the routine use of anti-GERD medications in the treatment of poorly controlled asthma of childhood. However large controlled trials of children symptomatic of both GERD and asthma have not been conducted, and in this case the benefits of treatment, although unproven, might outweigh the risks.
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Abstract
Asthma is one of the most common conditions seen in clinical practice and carries both a significant disease burden in terms of patient morbidity and a high economic burden in both direct and indirect costs. Despite this, it remains a comparatively poorly understood disease, with only modest advances in treatment over the past decade. Corticosteroids remain the cornerstone of therapy. Both patient compliance with medications and physician adherence to evidence-based guidelines are often poor, and a high percentage of patients continue to have inadequately controlled disease even with optimal therapy. Following a contextual overview of the current treatment guidelines, this review focuses on novel asthma therapies, beginning with the introduction of the leukotriene receptor antagonist zafirlukast in the 1990s, continuing through advanced endoscopic therapy and into cytokine-directed biologic agents currently in development. Along with clinically relevant biochemistry and pharmacology, the evidence supporting the place of these therapies in current guidelines will be highlighted along with data comparing these agents with more conventional treatment. A brief discussion of other drugs, such as those developed for unrelated conditions and subsequently examined as potential asthma therapies, is included.
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Hu ZW, Wang ZG, Wu JM, Tan ST. Anti-reflux procedure for difficult-to-treat asthmatic children, case report and literature review. Multidiscip Respir Med 2012; 7:28. [PMID: 22980911 PMCID: PMC3462718 DOI: 10.1186/2049-6958-7-28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/07/2012] [Indexed: 01/01/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a commonly encountered condition in children, which at times causes respiratory distress, such as asthmatic symptoms, and results in serious morbidity and even mortality. The complexity is sometimes so obscure, that it can cause paradoxical diagnoses and treatment. Here we present two cases of children with difficult-to-treat asthmatic symptoms, which were eventually found to be related to GERD. The two children were treated with anti-reflux procedures and both became symptom free. Literature was also reviewed to shed a light into this complex disease.
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Affiliation(s)
- Zhi-Wei Hu
- Xuanwu Hospital of Capital Medical University, Beijing, China.
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11
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Ratier JCDA, Pizzichini E, Pizzichini M. Gastroesophageal reflux disease and airway hyperresponsiveness: concomitance beyond the realm of chance? J Bras Pneumol 2012; 37:680-8. [PMID: 22042402 DOI: 10.1590/s1806-37132011000500017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/23/2011] [Indexed: 12/31/2022] Open
Abstract
Gastroesophageal reflux disease and asthma are both quite common the world over, and they can coexist. However, the nature of the relationship between these two diseases remains unclear. In this study, we review controversial aspects of the relationships among asthma, airway hyperresponsiveness, and gastroesophageal reflux disease in adults and in children.
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Blake K, Raissy H. Treatment of Pediatric Asthma with Proton Pump Inhibitors: Three Strikes, Game Over. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012. [DOI: 10.1089/ped.2012.0416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kathryn Blake
- Center for Clinical Pharmacogenomics and Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - Hengameh Raissy
- Health Sciences Center, School of Medicine, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
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Holbrook JT, Wise RA, Gold BD, Blake K, Brown ED, Castro M, Dozor AJ, Lima JJ, Mastronarde JG, Sockrider MM, Teague WG. Lansoprazole for children with poorly controlled asthma: a randomized controlled trial. JAMA 2012; 307:373-81. [PMID: 22274684 PMCID: PMC4153372 DOI: 10.1001/jama.2011.2035] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control in children despite inhaled corticosteroid treatment, but it is not known whether treatment with proton pump inhibitors improves asthma control. OBJECTIVE To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER. DESIGN, SETTING, AND PARTICIPANTS The Study of Acid Reflux in Children With Asthma, a randomized, masked, placebo-controlled, parallel clinical trial that compared lansoprazole with placebo in children with poor asthma control who were receiving inhaled corticosteroid treatment. Three hundred six participants enrolled from April 2007 to September 2010 at 19 US academic clinical centers were followed up for 24 weeks. A subgroup had an esophageal pH study before randomization. INTERVENTION Participating children were randomly assigned to receive either lansoprazole, 15 mg/d if weighing less than 30 kg or 30 mg/d if weighing 30 kg or more (n = 149), or placebo (n = 157). MAIN OUTCOME MEASURES The primary outcome measure was change in Asthma Control Questionnaire (ACQ) score (range, 0-6; a 0.5-unit change is considered clinically meaningful). Secondary outcome measures included lung function measures, asthma-related quality of life, and episodes of poor asthma control. RESULTS The mean age was 11 years (SD, 3 years). The mean difference in change (lansoprazole minus placebo) in the ACQ score was 0.2 units (95% CI, 0.0-0.3 units). There were no statistically significant differences in the mean difference in change for the secondary outcomes of forced expiratory volume in the first second (0.0 L; 95% CI, -0.1 to 0.1 L), asthma-related quality of life (-0.1; 95% CI, -0.3 to 0.1), or rate of episodes of poor asthma control (relative risk, 1.2; 95% CI, 0.9-1.5). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole vs placebo was observed for any asthma outcome. Children treated with lansoprazole reported more respiratory infections (relative risk, 1.3 [95% CI, 1.1-1.6]). CONCLUSION In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, compared with placebo, improved neither symptoms nor lung function but was associated with increased adverse events. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00442013.
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Abstract
Asthma significantly affects quality of sleep. Asthma physiology follows a diurnal pattern with peak flow at its lowest during early morning hours. The type and timing of release of inflammatory mediators also varies during the day and nighttime. Nocturnal symptoms are common in poorly controlled asthma. Hence, these nighttime symptoms play a significant role in the assessment of asthmatic patients as demonstrated in validated asthma control and quality of life questionnaires. Comorbid conditions may include allergic rhinitis, obesity, obstructive sleep apnea, and gastroesophageal reflux, all of which may worsen asthma symptoms, especially during sleep. In addition, exposure to greater loads of allergens in susceptible individuals during sleep is a significant problem and must be addressed to break the cycle of poor asthma control. Thus, asthma education for better symptom control should address these particular issues surrounding sleep.
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Affiliation(s)
- Catherine Kier
- Stony Brook University Medical Center, Stony Brook, New York
| | - Stephanie Hom
- Stony Brook University Medical Center, Stony Brook, New York
| | - Faiza Qureshi
- Stony Brook University Medical Center, Stony Brook, New York
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Pentiak P, Seder CW, Chmielewski GW, Welsh RJ. Benign post-esophagectomy gastrocardiac fistula. Interact Cardiovasc Thorac Surg 2011; 13:447-9. [PMID: 21788298 DOI: 10.1510/icvts.2011.276790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The development of a gastrocardiac fistula is a rare complication following retrosternal gastric conduit creation. We report a case of a 64-year-old male who presented three years after esophagectomy with massive hematemesis. A fistulous connection between his gastric conduit and right ventricle was identified and successfully treated. Although the patient had an atypical presentation and lacked most of the commonly cited risk factors, the combination of peptic ulcer disease and Candida overgrowth resulted in the formation of a gastrocardiac fistula. Adherence to treatment principles including prompt surgical intervention, adequate coverage of the repair, and antimicrobial therapy against Candida species provides the highest likelihood of success in addressing this potentially lethal disease process.
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Affiliation(s)
- Patricia Pentiak
- Division of General Surgery, Department of Surgery, William Beaumont Hospitals, Royal Oak, MI 48073, USA
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Bediwy AS, Elkholy MGA, Al-Biltagi M, Amer HG, Farid E. Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy. Int J Pediatr 2011; 2011:967460. [PMID: 22253635 PMCID: PMC3255283 DOI: 10.1155/2011/967460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/09/2011] [Accepted: 10/19/2011] [Indexed: 02/07/2023] Open
Abstract
Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV(1), peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV(1) in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV(1) and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV(1). Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.
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Affiliation(s)
- Adel Salah Bediwy
- 1Chest Department, Faculty of Medicine, Tanta University, Tanta 1084, Egypt
- *Adel Salah Bediwy:
| | | | | | - Hesham Galal Amer
- 3Internal Medicine Department, Faculty of Medicine, Minoufiya University, Shebeen El-Koom, Egypt
| | - Eman Farid
- 4Microbiology and Immunology Department, Faculty of Medicine, Benha University, Benha, Egypt
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