Algorithm for the diagnosis of gastroesophageal reflux disease in bronchial asthma

Algorithm for the diagnosis of gastroesophageal reflux disease in bronchial asthma

O.N. Titova¹, N.A. Kuzubova¹, L.F. Kovaleva¹, D.B. Sklyarova², D.I. Filippov³, A.A. Smirnov³

¹Research Institute of Pulmonology of the I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg

²Vvedenskaya City Clinical Hospital, Saint Petersburg

³Research Institute for Surgery and Emergency Medicine of the I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Aim: to develop an algorithm for the diagnosis of gastroesophageal reflux disease (GERD) in bronchial asthma (BA).

Patients and Methods: the study included 32 patients with a moderate to severely controlled and partially controlled BA course, observed at the Research Institute of Pulmonology of the I.P. Pavlov First Saint Petersburg State Medical University. All the patients received controller therapy according to the Federal Clinical Guidelines for the diagnosis and treatment of BA. The examination included the use of АСТ (Asthma Control Test), spirometry with a bronchodilator test, fibroesophagogastroduodenoscopy, consultation with a gastroenterologist, daily esophageal impedance pH monitoring, and Numerical Rating Scale for pain intensity.

Results: at the time of the examination, partial control over the BA symptoms was observed in 7 patients, the ACT score was 22.3±1.1 points. In this group of patients, the following association of respiratory manifestations was revealed — complaints concerning the respiratory organs (coughing, a feeling of "wheezing", non-productive habit cough, sternal pain, respiratory distress) in a horizontal position and the presence of GERD. The nature of reflux was determined, which was necessary for a differentiated approach to the prescription of anti-reflux therapy: acid reflux was detected in 1 patient, weakly acidic — in 2, mixed acid-base and severe reflux — in 3. Successful anti-reflux therapy allowed to reduce and completely eliminate the use of additional inhalations "on demand" of formoterol/budesonide by the end of 4 weeks.

Conclusion: the lack of possible BA control during the optimal controller therapy in some cases may be due to the presence of concomitant GERD. Timely diagnosis of GERD and its pharmacological correction contributes to achieving optimal BA control, reducing the doses of inhaled glucocorticosteroids and long-acting β₂-agonists, as well as preventing the progression and possible complications of GERD.

Keywords: bronchial asthma, gastroesophageal reflux disease, reflux, respiratory symptoms, spirometry, daily esophageal impedance pH monitoring.

For citation: Titova O.N., Kuzubova N.A., Kovaleva L.F. et al. Algorithm for the diagnosis of gastroesophageal reflux disease in bronchial asthma. RMJ. 2021;3:8–12.