University of Calgary,
Calgary, Alberta, Canada
Correspondence to: Stephen K. Field, MD, Division of Respiratory Medicine, Foothills Hospital, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada
To the Editor:
I would like to commend Harding et al (March 1999)1–
for publishing their extensive data on 24-h pH monitoring of asthma
patients. Several authors have reported the occurrence of respiratory
symptoms including cough, dyspnea, wheezing, and β-agonist use in
asthma patients in association with gastroesophageal reflux (GER)
symptoms.2–3 The findings of Harding et al confirm the
association between physiologic GER and the development of asthma
Despite the strong association between the two conditions, GER does not
consistently worsen objective measures of pulmonary function in asthma
and treating GER does not consistently improve them.4–5 A
review of the medical literature on antireflux therapy demonstrates a
paradox.5 Successful treatment of GER improves asthma
symptoms and asthma medication requirements but does not improve
pulmonary function.5 The data reported by Harding et al
confirm that GER causes respiratory symptoms, despite the existence of
other studies that fail to show consistent effects on pulmonary
function.1,4 Recognizing the existence of this paradox may
help to explain the nature of the relationship between the two
Previous authors have reported that GER can cause dyspnea and that
medical antireflux therapy improves it in nonasthmatic patients with
normal pulmonary function and negative results of methacholine
challenge tests.6–7 Changes in ventilation may explain an
improvement in respiratory symptoms without changes in pulmonary
function.8 Similar changes in asthma patients could
explain asthma symptoms and their response to antireflux therapy in the
absence of changes in pulmonary function.4–5 The study by
Harding et al emphasizes the need for further studies to determine
which asthma patients require esophageal testing and which will benefit
from antireflux therapy. Perhaps future studies of the effects of GER
and antireflux therapy should focus on changes in asthma symptoms and
quality of life rather than changes in pulmonary function.
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.