Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease

Victoria S. Benson， Hana Müllerová， Jørgen Vestbo， Jadwiga A. Wedzicha， Anant Patel， John R. Hurste， for the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators

Aim

To determine factors, overall and by sex, associated with self-reported gastro-oesophageal reflux disease (GORD) in chronic obstructive pulmonary disease (COPD) patients, and to evaluate relationships between GORD, its modification by acid suppression medications (Proton Pump Inhibitors [PPI]/histamine-2 receptor antagonists [H2RA]) and exacerbations of COPD and mortality.

Methods

Logistic regression was used to determine factors associated with GORD; Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for GORD and risk of exacerbation and death.

Results

Among 2135 COPD patients from the ECLIPSE cohort, 547 patients self-reported GORD, with female preponderance; 237 were taking PPI/H2RA. Risk factors for GORD did not differ by sex. When compared to patients who did not report GORD or use of PPI/H2RA, patients with GORD and taking PPI/H2RA had a significantly increased risk of exacerbation (HR = 1.58, 95%CI = 1.35–1.86); risk was also increased for patients reporting GORD only or PPI/H2RA use only (HR = 1.21 [1.04–1.40] and 1.33 [1.08–1.65], respectively). Similar findings were observed for risk of hospitalised exacerbation. GORD was not associated with mortality.

Conclusion

GORD in COPD patients is highly prevalent, and risk factors did not differ by sex. Use of PPI/H2RA and self-reported GORD were associated with increased risk of moderate-to-severe and hospitalised exacerbations.

respiratory medicine

September 2015Volume 109, Issue 9, Pages 1147–1154

DOI: http://dx.doi.org/10.1016/j.rmed.2015.06.009 |