Influence of spirometry on patient management in diagnostic studies unknown.

response is consistent with the main finding of our study, which was a reduction in asthma exacerbations. The main difference was the prominence of heartburn in our study and the prominence of upper airway symptoms in the reported case. However, many patients in our study also had symptoms of globus, hoarseness, and cough, and the patient in the reported case also had heartburn. Second, the severity of acid reflux and gastroesophageal reflux (GER) symptoms may predict a greater degree of improvement in asthmatic symptoms and pulmonary function in response to a PPI.1–3 Drs. Menon and Morice suggest that the symptom complex associated with LPR in asthmatics with ongoing asthma symptoms would also predict symptomatic and pulmonary function improvement with a PPI. However, atypical GER symptoms such as hoarseness compared to typical GER symptoms such as heartburn have not been obviously more successful in identifying patients whose asthma symptoms are likely to respond to a PPI.3 Our study also examined cough, globus, and hoarseness and found no difference in these symptoms with a PPI.4 In addition, several randomized, placebo-controlled trials5–7 have been inconsistent in demonstrating that a PPI resolves symptoms of LPR. These various observations indirectly suggest that LPR symptoms would not have been substantially more discriminatory than other symptoms such as heartburn in identifying patients whose asthma symptoms and pulmonary function would benefit from a PPI. However, to clarify the role of treatment of LPR to reduce asthma symptoms and improve pulmonary function, a properly performed randomized controlled trial is needed. Our study suggested that patients with GER whose asthma is treated with an inhaled corticosteroid plus other long-term asthma control therapy such as long-acting 2-agonists are more likely to have a reduction in asthma exacerbations and improvement in asthma-specific quality of life with a PPI.4 A more recent study2 found that asthmatics receiving a long-acting 2-agonist in addition to an inhaled corticosteroid and/or a leukotriene modifier are more likely to have improvement in morning and evening peak expiratory flow. Clearly, as stated in the penultimate paragraph of our article, more work is needed to identify patients whose asthma is most likely to benefit from acid suppressive therapy.