Increased Prevalence of Gastroesophageal Reflux Symptoms in Patients With COPD

doi:10.1378/chest.119.4.1043

Chest

Volume 119, Issue 4, April 2001, Pages 1043-1048

https://doi.org/10.1378/chest.119.4.1043 Get rights and content

Study objectives

To determine the prevalence of gastroesophageal reflux (GER) symptoms in patients with COPD and the association of GER symptoms with the severity of airways obstruction as assessed by pulmonary function tests (PFTs).

Design

Prospective questionnaire-based, cross-sectional analytic survey.

Setting

Outpatient pulmonary and general medicine clinics at a Veterans Administration hospital.

Patients

Patients with mild-to-severe COPD (n = 100) were defined based on American Thoracic Society criteria. The control group (n = 51) consisted of patients in the general medicine clinic without respiratory complaints or prior diagnosis of asthma or COPD.

Intervention

Both groups completed a modified version of the Mayo Clinic GER questionnaire.

Results

Compared to control subjects, a greater proportion of COPD patients had significant GER symptoms defined as heartburn and/or regurgitation once or more per week (19% vs 0%, respectively; p < 0.001), chronic cough (32% vs 16%; p = 0.03), and dysphagia (17% vs 4%; p = 0.02). Among patients with COPD and significant GER symptoms, 26% reported respiratory symptoms associated with reflux events, whereas control subjects denied an association. Significant GER symptoms were more prevalent in COPD patients with FEV₁≤≤ 50%, as compared with patients with FEV₁ > 50% of predicted (23% vs 9%, respectively; p = 0.08). In contrast, PFT results were similar among COPD patients with and without GER symptoms. An increased number of patients with COPD utilized antireflux medications, compared to control subjects (50% vs 27%, respectively; p = 0.008).

Conclusions

The questionnaire demonstrated a higher prevalence of weekly GER symptoms in patients with COPD, as compared to control subjects. There was a trend toward higher prevalence of GER symptoms in patients with severe COPD; however, this difference did not reach statistical significance. We speculate that although GER may not worsen pulmonary function, greater expiratory airflow limitation may worsen GER symptoms in patients with COPD.

Section snippets

Patient Selection

We consecutively enrolled 100 eligible patients with a diagnosis of COPD as defined by the American Thoracic Society,¹⁹ who were attending the outpatient pulmonary clinic at the Veterans Administration Chicago Health Care System, Lakeside Division. Inclusion criteria for COPD patients consisted of (1) age ≥≥ 50 years, (2)≥≥ 30 pack-year smoking history, and (3) abnormal findings on pulmonary function tests (PFTs) demonstrating nonreversible airways obstruction based on American Thoracic Society

Results

The demographic data of the 100 consecutively eligible patients with COPD and the 51 control subjects are presented in Table 1. All control subjects and 99 of 100 COPD patients were men. COPD patients and control subjects were matched for body mass index and alcohol consumption. Patients in the COPD group were slightly older than control subjects (mean age [± SD], 69.8 ± 7.6 years vs 65.8 ± 12.7 years, respectively; p = 0.04). As expected, the smoking pack-year exposures were greater in the

Discussion

The goals of this study were to determine the prevalence of GER symptoms in patients with COPD and to address the relationship between severity of airways obstruction and GER symptoms. The most important finding of this study is that significant GER symptoms (heartburn and/or acid regurgitation once or more per week) are more prevalent in patients with COPD when compared with control subjects at the same institution. We utilized a GER symptoms questionnaire that accurately reflects the presence

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: Drs. Barrett and Kamp are senior authors of this article.

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Chest

Clinical Investigations: COPDIncreased Prevalence of Gastroesophageal Reflux Symptoms in Patients With COPD

Study objectives

Design

Setting

Patients

Intervention

Results

Conclusions

Section snippets

Patient Selection

Results

Discussion

Dis Chest

Gastroenterology

Chest

Chest

Chest

Gastroenterology

Chest

Mayo Clin Proc

Lancet

J Allergy Clin Immunol

Gastroenterology

Gastroenterology

J Allergy Clin Immunol

Gastroenterology

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Clinical Investigations: COPD
Increased Prevalence of Gastroesophageal Reflux Symptoms in Patients With COPD