MINNEAPOLIS — Gastroesophageal reflux disease is a common comorbidity in chronic obstructive pulmonary disease and is linked to increased risk of acute exacerbations, hospitalization, emergency room visits, costs and quality-of-life impairment.
What remains unclear, however, is whether GERD contributes to the progression of COPD as measured by lung function or computed tomography, according to an article in the journal Respiratory Research.1
As a result, a Minneapolis VA Health Care System-led study sought to determine the impact of GERD on longitudinal changes in lung function and radiographic lung disease in the COPDGene cohort. GERD was reported by 2,101 (36.7%) participants at some point in that study.
The study team evaluated 5,728 participants in the COPD gene cohort who completed Phase I (baseline) and Phase II (five-year follow-up) visits. Participant-reported physician diagnoses was used to determine GERD status and 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 were evaluated using multivariable regression models. Researchers explained that the associations were further evaluated in the setting of GERD treatment with proton-pump inhibitors (PPI) and/or histamine-receptor 2 blockers (H2 blockers).
Results indicated that 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), although 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).
The study also found that, while patients with GERD had increased progression of QCT-measured air trapping (0.159%/year; 95% CI, 0.054 to 0.264), they did not demonstrate QCT metrics such as airway wall area/thickness or emphysema.
In terms of treatment, researchers determined that, 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).
“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 authors wrote. “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.”
- Baldomero AK, Wendt CH, Petersen A, Gaeckle NT, Han MK, Kunisaki KM; COPDGene Investigators. Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort. Respir Res. 2020 Aug 3;21(1):203. doi: 10.1186/s12931-020-01469-y. PMID: 32746820; PMCID: PMC7397645.