Study objectives: To determine the prevalence of
gastroesophageal reflux (GER) symptoms in patients with COPD and the
association of GER symptoms with the severity of airways obstruction as
assessed by pulmonary function tests (PFTs).
Prospective questionnaire-based, cross-sectional analytic survey.
Setting: Outpatient pulmonary and general medicine clinics
at a Veterans Administration hospital.
Patients with mild-to-severe COPD (n = 100) were defined based on
American Thoracic Society criteria. The control group (n = 51)
consisted of patients in the general medicine clinic without
respiratory complaints or prior diagnosis of asthma or COPD.
Intervention: Both groups completed a modified version of
the Mayo Clinic GER questionnaire.
to control subjects, a greater proportion of COPD patients had
significant GER symptoms defined as heartburn and/or regurgitation once
or more per week (19% vs 0%, respectively; p < 0.001), chronic
cough (32% vs 16%; p = 0.03), and dysphagia (17% vs 4%;
p = 0.02). Among patients with COPD and significant GER symptoms,
26% reported respiratory symptoms associated with reflux events,
whereas control subjects denied an association. Significant GER
symptoms were more prevalent in COPD patients with FEV1≤
50%, as compared with patients with FEV1 > 50% of
predicted (23% vs 9%, respectively; p = 0.08). In contrast, PFT
results were similar among COPD patients with and without GER symptoms.
An increased number of patients with COPD utilized antireflux
medications, compared to control subjects (50% vs 27%, respectively;
p = 0.008).
Conclusions: The questionnaire
demonstrated a higher prevalence of weekly GER symptoms in patients
with COPD, as compared to control subjects. There was a trend toward
higher prevalence of GER symptoms in patients with severe COPD;
however, this difference did not reach statistical significance. We
speculate that although GER may not worsen pulmonary function, greater
expiratory airflow limitation may worsen GER symptoms in patients with