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Original Research |

The potential role of aspiration in the asthmatic airway

Eoin B. Hunt, MD; Chris Ward, PhD; Stephen Power, MD; Ashley Sullivan, Bsc; Jeffrey Pearson, PhD; Susan Lapthorne, PhD; Paul M. O’Byrne, MD FCCP; Joseph Eustace, MD; Barry J. Plant, MD; Michael M. Maher, MD; John MacSharry, PhD; Desmond M. Murphy, MD FCCP
Author and Funding Information

Conflicts of Interest: BP has received speaker honoraria and consultancy fees from Gilead, Novartis, Vertex, Raptor, Pfizer and Menarini Pharmaceuticals. DMM has been awarded an APC grant from University College Cork and funding from the Wilton Respiratory Research Fund to support this research. He is the past recipient of an ERS fellowship. He has received fees for consultancy work from Novartis, Bayer, AstraZeneca, Menarini, Nycomed, Gilead, Boehringer Ingelheim, Teva, Rowex and Mundipharm. He has received speaker’s fees from Pfizer, Menarini, GSK, Bayer, MSD and Novartis. He has traveled to international symposia as a guest of Boehringer Ingelheim and Novartis. All others declare no conflicts of interest.

1The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland

2The Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

3The Department of Radiology, Cork University Hospital, Cork, Ireland

4The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland

5The Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

6The HRB Clinical Research Facility, University College Cork, Cork, Ireland

Corresponding Author: Dr. Desmond M Murphy, Consultant Respiratory Physician, The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.005
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Abstract

Background  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.

Methods  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.

Results  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.

Conclusion  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.


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