State of respiratory function and features of airway inflammation in children with asthma combined with gastroesophageal reflux disease

Abstract

The prevalence of gastroesophageal reflux disease (GERD) in children with asthma ranges from 32% to 80%. The intensity of respiratory symptoms, bronchial obstruction are more pronounced in children with asthma combined with GERD than in children with isolated asthma. However, there are limited and conflicting data on the difference between the induced sputum in asthmatic children with or without GERD. Purpose — to examine the status of lung function and features of airway inflammation in children with asthma combined with gastroesophageal reflux disease. Materials and methods. Sixty-seven children ages 6–17 years with moderate asthma and 30 healthy children ages 6–17 years were observed. They were assigned to three groups: group 1 (32 children with isolated asthma), and group 2 (35 children with asthma and GERD) and group 3 (30 healthy children). All children included in the study were identical in age and gender. Clinical assessment, spirometry with test of reversibility of airway obstruction, and cytological analysis of induced sputum samples were performed on all patients. Upper gastrointestinal endoscopy was done in the asthmatic groups. Results. There were 10 (28.57%) children in the 2nd group with first degree obstructive spirometry pattern and none in the 1st group of children. First degree restrictive spirometry pattern was more significant observed in the 1st group of children — 10 (31.25%) than in the 2nd group of children — 2 (5.71%) (OR, CI 95% 7.50 (1.50–37.57)). In the 2nd group of children, induced sputum had a significantly higher number of neutrophils, lymphocytes and macrophages compared to the 3rd group (p<0.05). Also the difference between these parameters were significant compared to the 1st group of children. The number of induced sputum epithelial cells in 2nd group was significantly less than in 1st group of children. Conclusions. GERD negatively affects the parameters of lung function in children with asthma. Airway inflammation in children with asthma combined with GERD appears to be more significant compared to isolated asthma. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the child s parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: asthma, gastroesophageal reflux disease, children, spirometry, induced sputum.