Abstract
We read with interest and compliment the review of ‘The relationship between gastroesophageal reflux and asthma: an update’. The authors write that current available data has shown limited benefit of treatment in symptomatic gastroesophageal reflux disease (GERD) with asthma and no clear benefit of asthma control. Reviewed data suggests empirical treatment of asymptomatic GERD in asthmatics is not a useful practice; instead, the clinician should focus on other factors which can affect asthma control [McCallister et al. 2011].
We present data suggesting GERD-induced asthma is different and can be treated by Stretta radiofrequency (RF) or laparoscopic fundoplication (LF).
The first piece of evidence is a doctor-cum-patient who suffered from life-threatening asymptomatic GERD-induced asthma was cured by LF [Wang et al. 2010b]. He has been doing well for more than 5 years and founded a Center for GERD where more than 2065 patients with mostly GERD-induced respiratory symptoms treated by RF or LF achieved various levels of relief, including one in three free of dyspnea.
The second piece of evidence is a RF study for 505 patients with mainly wheezing and chronic cough enrolled from April 2006 to October 2008. A six-point scale questionnaire was used to assess symptom severity and frequency. The score was the sum of both of these symptom measures. Wheezing score decreased from 7.83 to 3.07, cough from 6.77 to 2.85, heartburn from 5.31 to 1.79 (p < 0.01) at a mean follow-up of 12 months [Gao et al. 2011]. Some patients had multiple rescues or tracheotomy or pneumectomy or were even candidates for lung transplantation. After diagnosis was confirmed and RF applied, all had dyspnea relief, and had a resumption of normal life, although without improving parenchymal damage [Wang et al. 2009].
The third piece of evidence is a study of LF on GERD-related respiratory symptoms, from January 2007 to October 2008. Sixty four such patients were consecutively enrolled. Diagnosis was confirmed by esophageal probe and gastroscopy. Relief of respiratory symptoms after surgery was excellent in 23 cases (35.9%), good in 28 cases (43.8%), fair in 5 cases (7.8%) and poor in 8 cases (12.5%). Mean respiratory symptom score decreased from 6.3 ± 2.65 to 2.33 ± 2.37 [Wang et al. 2010a].
The final piece of evidence is an animal study that revealed the predominant cells were neutrophils rather than eosinophils in bronchoalveolar lavage of GERD triggered airway inflammation [Lai et al. 2009].
Thus, GERD-induced asthma is a different treatable entity than severe or uncontrolled asthma.