Asthma: no clear benefit from treating reflux oesophagitis

Clinical bottom line (level 2a-)

  1. Patients with asthma and reflux oesophagitis who receive treatment for reflux oesophagitis compared with none do not clearly have an improvement in pulmonary function or nocturnal asthma symptoms
Coughlan et al: BMJ 2001; 56 : 198-204
Expires May 2004

The study

Systematic review of all randomised or quasi-randomised controlled trials of
  • Patients: asthma and reflux oesophagitis
  • Intervention: treatment for reflux oesophagitis: conservative anti-reflux measures, H-2 antagonists, proton-pump inhibitors, cisapride, Nissen fundoplication compared with no treatment
  • Outcome: pulmonary function, asthma medication use

Articles found in all languages using Cochrane controlled trials register (including Medline, Embase, CINAHL, 20 hand-searched respiratory journals, and meeting abstracts, 1966 to April 2000 (search terms: ) and contacting pharmaceutical companies and authors and searching bibliographies of retrieved articles

Selection criteria: by 2 independent reviewers
Appraisal criteria: by 2 independent reviewers using Jadad criteria (randomisation, concealment allocation, blinding and follow-up)
Articles excluded if:
  • patients did not have reflux or asthma
  • interventions did not treat reflux
12 RCTs found involving 432 patients
Study results were not significantly heterogeneous.

The evidence

  • treatment v. control: weighted mean difference in morning PEFR: -5 l/min (95% CI: -24 to 34)
  • treatment v. control: weighted mean difference in evening PEFR: 7 l/min (95% CI: -26 to 40)
  • treatment v. control: weighted mean difference in nocturnal asthma score: 0.16 (95% CI: -0.11 to 0.42)

Comments

  1. No study reported any effects on hospital admissions or asthma attacks.

Citation

  1. Coughlan JL, Gibson PG, Henry RL: medical treatment for reflux oesophagitis does not consistently improve asthma control: a systematic review. BMJ 2001; 56 : 198-204
Search Terms: from ACP Journal Club
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient asthma and reflux oesophagitis
Intervention or Exposure treatment for reflux oesophagitis
Outcome pulmonary function