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Clinical Investigations: AsthmaAutonomic Regulation in Asthmatics With Gastroesophageal Reflux
Section snippets
Subjects
Fifteen adult asthmatics with reflux participated in this prospective study approved by the Human Use Committee at the University of Alabama at Birmingham on March 9, 1994. All subjects had a thorough history, baseline pulmonary function tests (PFTs), esophageal manometry, and outpatient 24-h esophageal pH test prior to entry into the study.
All subjects had clinical symptoms of asthma and met the American Thoracic Society's definition of asthma, including a (1) 20% improvement in FEV1 after
Group Demographics
Fifteen subjects with asthma and GER participated. The group's mean age was 36.4 years (range, 25 to 58 years). Forty percent were men. The mean length of asthma symptoms was 18.6 years (range, 2 to 43 years). Eight subjects (53%) had nocturnal asthma symptoms. Table 1 summarizes asthma medication use, asthma severity, spirometry, 24-h esophageal pH test, and esophageal manometry of subjects with asthma and GER.
Pulmonary function data show the absence of significant large airway obstruction;
DISCUSSION
The esophagus and bronchial tree share embryonic foregut origin and vagal innervation.27 Thus, acid in the esophagus could stimulate acid-sensitive receptors initiating a vagally mediated reflex through shared esophageal and bronchial autonomic innervations.28, 29, 30, 31 This reflex could lead to bronchoconstriction in asthmatics with reflux.
Many studies support that a vagally mediated esophagobronchial reflex exists.7, 8, 9, 10, 11, 12 This led us to hypothesize that asthmatics with reflux
ACKNOWLEDGMENTS
The authors thank Drs. K. Randall Young, Joel E. Richter, and James R. Bonner for their support, Delancy Gardner, RPFT, Jean Price, MT (ASP), and Susan Irwin, RN, BSN, for assistance, and Jeanine A. Moore, BA, for her invaluable assistance in editing this manuscript.
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Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review
2017, Brazilian Journal of OtorhinolaryngologyGastroesophageal reflux is not associated with short-term variability of parasympathetic activity in children
2017, Advances in Medical SciencesCan bronchial asthma with an highly prevalent airway (and systemic) vagal tone be considered an independent asthma phenotype? Possible role of anticholinergics
2016, Respiratory MedicineCitation Excerpt :Asthma induced by gastro-esophageal reflux (GER) is still a controversial issue especially for the difficulties to explain the exact mechanism of inducing bronchial hyperreactivity by esophageal acid [32]. In recent years a possible association between airway narrowing, GER and cholinergic tone has been postulated [33,34]. Acid stimulation of the distal esophagus induced by stomach acid results in increased cholinergic tone and a concomitant bronchoconstriction in asthmatics irrespective of their reflux state [35,36].
Gastro-esophageal reflux and chronic respiratory diseases
2015, Revue des Maladies RespiratoiresEvidence-Based Practice. Reflux in Sinusitis
2012, Otolaryngologic Clinics of North AmericaSinonasal Problems and Reflux
2012, Facial Plastic Surgery Clinics of North AmericaCitation Excerpt :This mechanism may involve dysfunction of the autonomic nervous system, resulting in sinonasal edema and secondary ostial obstruction. This disorder has been shown in the lower airway by Lodi and colleagues14 and Harding and colleagues.15 They found that patients with asthma and GER disease have exaggerated vagal responsiveness, compared with age-matched controls.
Presented in abstract form at Digestive Disease Week (American Gastroenterological Association), May 21, 1996, San Francisco.
Dr. Harding is supported by NIH Physician Scientist Award, National Heart, Lung and Blood Institute, grant No. K 11-ML 022195.