Many asthmatics remain sub-optimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastro-esophageal reflux (GER). We aimed to investigate whether aspiration occurs in asthmatic patients and if so does it correlate with asthma control.
Patients had ACQ-7, FeNO, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration. Patients underwent bronchoscopic investigation, with bronchoalveolar lavage (BAL) pepsin measured as a marker of aspiration.
Seventy-eight patients stratified by disease severity (GINA) into mild (35.8%), moderate (21.7%) and severe (42.3%) were studied. Pepsin was detectable in BAL in 46/78 (58.9%). There were no differences between pepsin levels in patients with different disease severity. Furthermore, no significant associations were seen between pepsin level and measures of asthma control, FEV1, ACQ or exacerbation frequency. Similarly no associations were found with adjustments for smoking history, BMI, proton pump inhibitor use, eosinophil count or IgE. When stratified into eosinophilic or neutrophilic asthmatic populations based on BAL there was no relationship to detected pepsin concentrations. A positive barium swallow (seen in 33/60 patients) did not correlate with BAL pepsin level and we found no significant association between barium swallow result and ACQ, GINA, exacerbation frequency or FEV1 using either univariate or multivariate analyses.
Our study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be over-stated. However, our study did not address the role of aspiration and future risk of exacerbation.