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Editorials |

Not the Perfect Study, but Helpful Wisdom for Treating Asthma Patients With Gastroesophageal Reflux Disease

Joel E. Richter
Author and Funding Information

Affiliations: Cleveland, OH
 ,  Dr. Richter is Chairman and Professor of Medicine, Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation.

Correspondence to: Joel E. Richter, MD, Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, 9500 Euclid Ave, A30, Cleveland, OH 44195



Chest. 2003;123(4):973-975. doi:10.1378/chest.123.4.973
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Several years ago for this same journal, I wrote an editorial entitled “Asthma and Gastroesophageal Reflux Disease: The Truth Is Difficult To Define.”1 In that editorial and another review article,2 I outlined the major limitations in current studies on this subject and lamented our progress over the last 20 years in resolving this complex interaction. Over the last 3 years in the adult literature, it is disappointing that only one study has addressed this subject using a placebo-controlled crossover design and omeprazole, 40 mg for 4 weeks.3 The sample size was only five patients, and they found no improvement in pulmonary function tests results. On the other hand, this issue of CHEST (see page 1008) has an excellent study by Khoshoo and colleagues, which overcomes many of the methodological limitations of other studies and defines better the role of gastroesophageal reflux disease (GERD) treatment with proton pump inhibitors (PPIs) in children with difficult-to-control asthma. Impressively, this study was not performed in an academic medical center but rather by dedicated physicians in private practice who are interested in asthma and GERD, and who worked together to define an effective clinical algorithm for approaching all of their difficult-to-manage asthma patients. Let us look at the relevance of this important study to the methodological limitations of many previous studies relating asthma and GERD.,2

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