Is gastro-oesophageal reflux associated with COPD exacerbations?

COPD is an important long-term condition associated with considerable disability, with a large unmet need for novel therapeutic approaches. The course of COPD is characterized by episodes of respiratory symptom worsening termed exacerbations, (1) and these events are now known to affect health status and disease progression and to be a major factor in the need for hospital admission and readmission. These COPD exacerbations are costly to healthcare services worldwide, and, although a number of pharmacological therapies alone or in combination prevent COPD exacerbations, reductions in exacerbation rates of only about 25% have been observed. Thus, novel additional approaches targeting specific pathophysiological mechanisms are essential for COPD patients. Although exacerbations generally increase in frequency with increasing disease severity, approximately 22% of the patients with moderate COPD in one observational study (FEV 1 = 50-80% of the predicted value) were found to be particularly susceptible to COPD exacerbations and have two or more treated events per year despite usual therapy. These frequent exacerbators have been shown to have a relatively stable exacerbation frequency phenotype, and the number of exacerbations in one year predicts the number of events that are likely to occur in subsequent years. A number of studies have highlighted the importance of gastro-oesophageal reflux (GOR) as a co-morbidity in COPD. This is not unsurprisng as GOR symptoms are common with increasing age in the population. That same observational study also showed that the presence of gastro-oesophageal reflux (GOR) was related to exacerbation frequency in COPD with the frequent exacerbators having a greater chance of developing GOR symptoms. In that study, the prevalence of self-reported GOR was at 27%, and this was similar to the prevalence in other studies in COPD. However, it is known that self-reported GOR may underestimate the true prevalence as GOR may occur in the absence of symptoms and validated questionnaires need to be used to assess GORD in COPD. In the present issue of the Brazilian Journal of Pulmonology, Sakae and colleagues present an interesting paper in which they have performed a systematic review and meta-analysis on the relationships between GOR symptoms and exacerbation frequency. The review confirmed the association between exacerbations and GOR and showed that the risk of having a COPD exacerbation was seven times higher in GOR patients than in those without GOR. Furthermore, the authors also showed that patients with COPD have a significantly higher prevalence of GOR than those without …