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Original Research: COPD |

Relationship Between Gastroesophageal Reflux Disease and COPD in UK Primary Care

Luis A. García Rodríguez, MD; Ana Ruigómez, MD, PhD; Elisa Martín-Merino, BPharm; Saga Johansson, MD, PhD; Mari-Ann Wallander, PhD
Author and Funding Information

*From the Spanish Centre for Pharmacoepidemiological Research (Drs. García Rodríguez and Ruigómez and Ms. Martín-Merino), Madrid, Spain; and AstraZeneca R&D (Drs. Johansson and Wallander), Mölndal, Sweden.

Correspondence to: Luis A. García Rodríguez, MD, Spanish Centre for Pharmacoepidemiological Research (CEIFE), Almirante 28, 2°, 28004 Madrid, Spain; e-mail: lagarcia@ceife.es


This study was performed at the Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain.

Editing assistance by Dr. Catherine Hill from Oxford PharmaGenesis was funded by AstraZeneca.

Drs. Johansson and Wallander are employees of AstraZeneca. Drs. García Rodríguez and Ruigómez and Ms. Martín-Merino are employees of the Spanish Centre for Pharmacoepidemiological Research, which has received research grants from AstraZeneca.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(6):1223-1230. doi:10.1378/chest.08-0902
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Background:  Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care.

Methods:  We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis.

Results:  During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease.

Conclusions:  Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.

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