Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease.

BACKGROUND AND AIM: It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries. METHODS: A validated GERD questionnaire was conducted face-to-face with 308 consecutive asthma (240 women) and 133 COPD (35 women) patients in the tertiary referral pulmonary outpatient clinic, and 694 controls from the research area. Detailed histories of patients and pulmonary function tests were also recorded. RESULTS: The prevalence of GERD (heartburn/regurgitation once a week or more) was 25.4%, 17.0%, 19.4% and occasional symptoms (less than weekly) were 21.2%, 16.3% and 27.0% of patients with asthma, COPD and controls, respectively. The prevalence was higher in the asthma group compared with the controls and the COPD group. No significant difference was found between the COPD group and the controls. Heartburn started following pulmonary disease in 24.1% of the asthma group, and 26.4% of the COPD group. The majority of additional symptoms were significantly higher in asthmatics compared with the controls. No difference was found in the consumption of pulmonary medications in asthmatic patients in groups with different symptom frequency. Heartburn was increased 13.8% by the consumption of inhaler medications. CONCLUSIONS: These results implicate that the prevalence of GERD in asthma and COPD are lower than in published reports in a tertiary referral center. These differences might be related to the characteristics of developing countries, increased consumption of powerful medications in GERD and pulmonary diseases, or methodological flaws in earlier studies.

The effect of inhaled corticosteroids on bronchoalveolar lavage cells and IL-8 levels in stable COPD patients.

Chronic obstructive pulmonary disease (COPD) is characterised by a chronic inflammatory process in the large and small airways, as well as in the lung parenchyma. Although the role of oral corticosteroids in the management of acute exacerbations of COPD is well documented, its role in stable COPD is not clear. We examined the anti-inflammatory effect of inhaled budesonide on the percentage of neutrophils and on interleukin-8 (IL-8) levels in bronchoalveolar lavage (BAL) and their correlation with spirometry and symptom scores. Twenty-six patients with stable COPD were randomised, in a double-blinded, placebo-controlled trial with either 800 microg of inhaled budesonide or placebo for a 6-month period. The budesonide-treated subjects had significant reductions in IL-8 levels in the BAL after therapy (mean+/-sem, 1.53+/-0.72 at baseline vs. 0.70+/-0.48 ng/ml at 6 months, P=0.004) and a reduction in the mean percentages of neutrophils (17.16+/-2.67% vs. 13.25+/-2.28% P=0.002). The improvement in sputum production was of borderline (P=0.058) significance but there was no improvement in lung function. In stable patients with COPD, treatment with inhaled budesonide for a period of 6 months has a positive effect on markers of lung inflammation, as assessed by reduction in percentage neutrophils and IL-8 concentration in BAL.

Success of a smoking cessation program among smoking relatives of patients with serious smoking-related pulmonary disorders.

The aim of the study was to investigate the success of a smoking cessation program among the smoking relatives of patients with serious smoking-related disorders and to determine whether having a relative with such a disorder influences the rate of success of the program. The relatives of patients with chronic obstructive pulmonary disease (COPD) and lung cancer who wanted to quit smoking were included in the smoking cessation program (group I, n = 34). During the same period, the same number of subjects with relatives free of any smoking-related diseases were included as a control group (group II, n = 34). Intensive behavioral therapy and motivational support was given to all subjects. Nicotine replacement therapy was administered to 10 subjects (29.4%) in group I and 14 subjects (41.2%) in group II. The subjects were evaluated in the 1st, 2nd, 4th, 8th and 12th week and subsequently every 3 months for a year in the outpatient clinic and proactive telephone interviews were performed periodically. In group I, 23.5% of subjects had a relative with COPD, 61.8% had relatives with lung cancer, and 14.7% had relatives with both COPD and lung cancer. The rate of quitting smoking was 79.4 and 73.5% on the 15th day and 41.2 and 38.2% at the end of the 1st year in groups I and II, respectively (p > 0.05). We observed that having a relative with serious smoking-related disorders did not motivate smokers to quit smoking.