The relationship of gastroesophageal reflux disease and asthma control.

Purpose: To study whether ACT responses are confounded by gastro-esophageal status (GERD), and if this is in concordance with the variation in Forced Expiratory Volume in 1 second (FEV1%) and Fractional Excretion of Nitric Oxide (FeNO). Materials and Methods: This is a prospective cohort study (n = 307). Patients were surveyed for demographics data, and underwent ACT scoring, FEV1% and FeNO testing. Results: Patients with GERD had mean ACT scores that were 4.1 (p < .001) lower than without-GERD group. Not-well-controlled asthmatics (FEV1% <80, high FeNO) with-GERD had mean ACT scores that were 2.9 (p < .001) for FEV1% <80 and 3.8 (p = .008) for high FeNO lower than without-GERD group respectively. Well-controlled asthmatics (FEV1% ≥80, low FeNO) with-GERD had mean ACT scores that were 5.2 (p < .001) for FEV1% ≥80 and 5.1 (p < .001) for low FeNO lower than without-GERD group respectively. Conclusion: Our study demonstrates that symptoms of GERD can lead to an inaccurate perception of asthma control and ACT as compared to objective measures, such as FEV1% and FeNO. Hence, this can lead to mismanagement of asthma, especially when objective measures are not conducted along with ACT.

The effect of the socioeconomic status on the measurement of asthma control.

Background: The Asthma Control Test (ACT) is a commonly used scoring system for evaluation of asthma control in the pediatric and adult populations. Asthma control has been deemed poor in those economically disadvantaged. Objective: To study whether the ACT is affected by socioeconomic status (SES) as evaluated by the percentage of the federal poverty level and the education level. Methods: This was a cross-sectional study (N = 307), in which the patients were surveyed for demographics data and underwent ACT scoring, spirometry (forced expiratory volume in the first second of expiration) and fractional concentration of exhaled nitric oxide testing. Results: There was a positive correlation of improved mean score on the ACT (p < 0.001) with higher education status and higher federal poverty level status. Conclusion: SES plays a factor in the way patients perceived their asthma control, and therefore affected how they scored on the ACT.

Anticoagulation in Pulmonary Arterial Hypertension: Do We Know the Answer?

The shear stress and hypoxia in the pulmonary artery in patients with pulmonary arterial hypertension(PAH) causes endothelial dysfunction, smooth muscle proliferation and activation of thrombotic pathways leading to in situ thrombosis. Targeting the thrombotic pathways is a proposed mechanism to slow disease progression and improve survival. Over the years, the survival in patients with PAH has improved due to multiple factors with the increased use of anticoagulation as one of them. Both European Respiratory Society/European Society of Cardiology and American College of Cardiology/American Heart Association guidelines make grade II recommendations for using anticoagulation in PAH. The guidelines are based on weak observational studies with high risk of bias which have only studied warfarin as the choice of anticoagulation. In this article, we review the pathophysiology, rationale and the current literature investigating the role of anticoagulation in PAH.