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Impact of self-reported gastroesophageal reflux disease in subjects from COPDGene cohort.

ABSTRACT: The coexistence of gastroesophageal reflux disease (GERD) and COPD has been recognized, but there has been no comprehensive evaluation of the impact of GERD on COPD-related health status and patient-centered outcomes.Cross-sectional and longitudinal study of 4,483 participants in the COPDGene cohort who met GOLD criteria for COPD. Physician-diagnosed GERD was ascertained by questionnaire. Clinical features, spirometry and imaging were compared between COPD subjects without versus with GERD. We evaluated the relationship between GERD and symptoms, exacerbations and markers of microaspiration in univariate and multivariate models. Associations were additionally tested for the confounding effect of covariates associated with a diagnosis of GERD and the use of proton-pump inhibitor medications (PPIs). To determine whether GERD is simply a marker for the presence of other conditions independently associated with worse COPD outcomes, we also tested models incorporating a GERD propensity score.GERD was reported by 29% of subjects with female predominance. Subjects with GERD were more likely to have chronic bronchitis symptoms, higher prevalence of prior cardiovascular events (combined myocardial infarction, coronary artery disease and stroke 21.3% vs. 13.4.0%, p?

SUBMITTER: Martinez CH

PROVIDER: S-EPMC4049804 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Impact of self-reported gastroesophageal reflux disease in subjects from COPDGene cohort.

Martinez Carlos H CH Okajima Yuka Y Murray Susan S Washko George R GR Martinez Fernando J FJ Silverman Edwin K EK Lee Jin Hwa JH Regan Elizabeth A EA Crapo James D JD Curtis Jeffrey L JL Hatabu Hiroto H Han MeiLan K MK

Respiratory research 20140603

<h4>Background</h4>The coexistence of gastroesophageal reflux disease (GERD) and COPD has been recognized, but there has been no comprehensive evaluation of the impact of GERD on COPD-related health status and patient-centered outcomes.<h4>Methods</h4>Cross-sectional and longitudinal study of 4,483 participants in the COPDGene cohort who met GOLD criteria for COPD. Physician-diagnosed GERD was ascertained by questionnaire. Clinical features, spirometry and imaging were compared between COPD subj ...[more]

PMID: 24894541

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Project description:RATIONALE:Gastroesophageal reflux disease (GERD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and has been associated with increased risk of acute exacerbations, hospitalization, emergency room visits, costs, and quality-of-life impairment. However, it remains unclear whether GERD contributes to the progression of COPD as measured by lung function or computed tomography. OBJECTIVE:To determine the impact of GERD on longitudinal changes in lung function and radiographic lung disease in the COPDGene cohort. METHODS:We evaluated 5728 participants in the COPDGene cohort who completed Phase I (baseline) and Phase II (5-year follow-up) visits. GERD status was based on participant-reported physician diagnoses. We evaluated associations between GERD and annualized changes in lung function [forced expired volume in 1?s (FEV1) and forced vital capacity (FVC)] and quantitative computed tomography (QCT) metrics of airway disease and emphysema using multivariable regression models. These associations were further evaluated in the setting of GERD treatment with proton-pump inhibitors (PPI) and/or histamine-receptor 2 blockers (H2 blockers). RESULTS:GERD was reported by 2101 (36.7%) participants at either Phase I and/or Phase II. GERD was not associated with significant differences in slopes of FEV1 (difference of -?2.53?mL/year; 95% confidence interval (CI), -?5.43 to 0.37) or FVC (difference of -?3.05?mL/year; 95% CI, -?7.29 to 1.19), but the odds of rapid FEV1 decline of ?40?mL/year was higher in those with GERD (adjusted odds ratio (OR) 1.20; 95%CI, 1.07 to 1.35). Participants with GERD had increased progression of QCT-measured air trapping (0.159%/year; 95% CI, 0.054 to 0.264), but not other QCT metrics such as airway wall area/thickness or emphysema. Among those with GERD, use of PPI and/or H2 blockers was associated with faster decline in FEV1 (difference of -?6.61?mL/year; 95% CI, -?11.9 to -?1.36) and FVC (difference of -?9.26?mL/year; 95% CI, -?17.2 to -?1.28). CONCLUSIONS:GERD was associated with faster COPD disease progression as measured by rapid FEV1 decline and QCT-measured air trapping, but not by slopes of lung function. The magnitude of the differences was clinically small, but given the high prevalence of GERD, further investigation is warranted to understand the potential disease-modifying role of GERD in COPD pathogenesis and progression. CLINICAL TRIALS REGISTRATION:NCT00608764 .

Dataset Information

Impact of self-reported gastroesophageal reflux disease in subjects from COPDGene cohort.

Publications

Impact of self-reported gastroesophageal reflux disease in subjects from COPDGene cohort.

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