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Original Research: Asthma |

The Potential Role of Aspiration in the Asthmatic Airway

Eoin B. Hunt, MD; Chris Ward, PhD; Stephen Power, MD; Ashley Sullivan, BSc; Jeffrey P. 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

Drs MacSharry and Murphy contributed equally to this manuscript.

FUNDING/SUPPORT: Dr Murphy has received funding from the Wilton Respiratory Research Fund to support this research. Drs Murphy and MacSharry have been awarded a Translational Research Access Programme award from University College Cork. Dr Hunt has received a Denis O'Sullivan Fellowship award from University College Cork.

aDepartment of Respiratory Medicine, Cork University Hospital, Cork, Ireland

bThe Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England

cThe Department of Radiology, Cork University Hospital, Cork, Ireland

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

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

fThe HRB Clinical Research Facility, University College Cork, Cork, Ireland

CORRESPONDENCE TO: Desmond M. Murphy, MD, FCCP, Consultant Respiratory Physician, The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1272-1278. doi:10.1016/j.chest.2017.03.005
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Background  Many people with asthma remain suboptimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastroesophageal reflux. We aimed to investigate whether aspiration occurs in patients with asthma and, if so, does it correlate with asthma control?

Methods  Patients had Asthma Control Questionnaire 7 (ACQ-7), fractional exhaled nitric oxide, 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 BAL pepsin measured as a marker of aspiration.

Results  Seventy-eight patients stratified by disease severity (Global Initiative for Asthma) 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-7 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 on the basis of 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-7, Global Initiative for Asthma, exacerbation frequency or FEV1 using either univariate or multivariate analyses.

Conclusions  This study suggests that the importance of aspiration on current asthma symptom control and exacerbation rate may be overstated. However, this study did not address the role of aspiration and future risk of exacerbation.

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