Chest
Volume 111, Issue 1, January 1997, Pages 65-70
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Clinical Investigations: Asthma
Autonomic Regulation in Asthmatics With Gastroesophageal Reflux

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Study objective

To study the role of autonomic regulation in asthmatics with gastroesophageal reflux (GER).

Design

Prospective study.

Setting

Autonomic function laboratory of a 908-bed university hospital.

Participants

Fifteen nonsmoking asthmatics with GER (six men, nine women; average age, 36 years). Interventions: Subjects were connected to an ECG monitor. BP was measured by sphygmomanometer at set intervals. After a resting period, each subject had heart rate and BP monitored during an 80° passive tilt, Valsalva maneuver, quiet and deep breathing, handgrip, and an echo stress test of cortical arousal. Each autonomic function test was analyzed and defined as normal, hypervagal, hyperadrenergic, or mixed (a combination of hypervagal and hyperadrenergic responses) as compared with 23 age-matched normal control subjects from our laboratory (14 men, 9 women; average age, 35 years) and published normal control values. Each subject had an overall response score that was determined by the results of the tilt, Valsalva maneuver, and deep breathing maneuvers.

Results

All asthmatics with reflux had at least one autonomic function test display a hypervagal response. Overall response scores show that eight of 15 asthmatics with GER had an overall hypervagal response, and seven had a mixed response. Of the seven asthmatics with GER who had a mixed response score, two had a hypervagal predominant response.

Conclusions

Asthmatics with GER have evidence of autonomic dysfunction. Heightened vagal tone may be partially responsible for the heightened airway responsiveness to esophageal acidification in asthmatics with 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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    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.

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