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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.
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PMID:Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. 229 59

To examine the efficacy of targeted inspiratory muscle training (IMT), 25 patients with moderate COPD were randomly assigned to one of three groups. Eight patients received IMT along with general exercise reconditioning, GER+IMT; nine patients received general exercise reconditioning, GER; eight patients received sham breathing exercises, CONTROL. All groups used a spring-loaded inspiratory muscle trainer; however, the GER and CONTROL groups breathed through these devices at only 15% of their maximal inspiratory pressure. The GER+IMT group increased the load on these devices until at 6 wk the load was equal to 80% of their maximal inspiratory pressure. All patients exercised three times per week for a 12-wk period in supervised sessions. Analysis of covariance revealed no significant differences in spirometric measurements, maximal inspiratory pressure, or maximal oxygen consumption among any of the three groups after the intervention (p > 0.05). Twelve-minute walk distance was significantly greater in the GER+IMT and GER groups than in the CONTROL group (p = 0.03). After the intervention, there was a trend (p = 0.08) for treadmill time to be greater for the GER+IMT and GER groups than for the CONTROL group. Dyspnea ratings at different exercise intensities were not found to be significantly different among the three groups after the intervention. These results demonstrate that GER+IMT and GER alone are equally effective in improving exercise performance in patients with COPD. Additionally, the combination of GER and IMT does not appear to provide any clinically significant improvements in exercise performance or perceptions of dyspnea during exercise when compared with GER alone.
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PMID:Inspiratory muscle training and whole-body reconditioning in chronic obstructive pulmonary disease. 866 39

In difficult-to-manage asthma, effective control depends on identification and alleviation of exacerbating factors, such as ongoing allergen exposure, chronic sinusitis, GERD, and emotional stress. Level of compliance with the prescribed medication regimen should be evaluated in all patients. Hormonal factors (i.e., menses, use of exogenous hormones by female patients, and hyperthyroidism) also can exacerbate asthma. When aggressive management fails, the possibility of a misdiagnosis should be considered. Other conditions that can mimic asthma include COPD, congestive heart failure, airway obstruction due to various causes, vocal cord dysfunction, and esophageal spasm. Referral to an asthma specialist is advised in severe or resistant cases.
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PMID:Difficult-to-manage asthma. How to pinpoint the exacerbating factors. 1109 58

Acute exacerbation of chronic bronchitis (AECB) is a very common condition, which presents with deteriorating sputum production and dyspnoea in a patient with pre-existing COPD or chronic bronchitis. As these symptoms are relatively non-specific and also the presenting feature of a wide range of other conditions, the physician should carefully consider the differential diagnosis before deciding on whether or not a patient indeed has AECB. The differential diagnosis can be summarised as pneumonia, pneumothorax, cardiac failure/cor pulmonale, bronchiectasis, asthma, tuberculosis, sinusitis and other forms of upper respiratory tract sepsis, diffuse panbronchiolitis, lung cancer, gastro-oesophageal reflux, the presence of a foreign body in the airway, melioidosis, and lung abscess. This article aims to discuss these conditions, with brief presentation of clinical cases, in the evaluation of differential diagnosis of AECB.
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PMID:Solutions for difficult diagnostic cases of acute exacerbations of chronic bronchitis. 1158 3

The intimate anatomical and physiologic relationship between the upper airway and esophagus consists of complex interactions between various muscles and nerves with both voluntary and involuntary patterns of control. Alterations in this harmonic relationship can lead to swallowing abnormalities ranging from dysphagia to gross aspiration, gastroesophageal reflux disease (GERD) and chronic cough. There is a paucity of data regarding pathologic alterations in the upper airway-esophageal relationship in patients with COPD. The association between GERD and respiratory symptoms is well recognized in the setting of asthma; however, the nature of this relationship remains controversial. The association of GERD and COPD is even less clear. A review of the limited data on GERD and swallowing abnormalities in patients with COPD indicate that prevalence of GERD and esophageal disorders in patients with COPD is higher than in the normal population. However, its contribution to respiratory symptoms, bronchodilator use and pulmonary function in patients with COPD remains unknown. Although dysphagia and swallowing dysfunction on videofluoroscopic swallow evaluation are common in patients with COPD, their role as exacerbators of COPD remains to be elucidated. Further clinical research is necessary to evaluate the role of GERD and swallowing dysfunction in both stable and acute exacerbation of COPD.
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PMID:Clinical implications of gastroesophageal reflux disease and swallowing dysfunction in COPD. 1472 11

Extensive evidence links cardiovascular disease and sleep disordered breathing. OSA has adverse effects on blood pressure, cardiovascular status,and mortality. Effective CPAP therapy can improve blood pressure and cardiac function in patients who have OSA. Patients who have congestive heart failure have a high prevalence of sleep-disordered breathing, with OSA occurring in 30% of such patients and Cheyne-Stokes respiration in 40%.CPAP is the preferred mode of therapy for both types of sleep-disordered breathing in patients who have coexistent congestive heart failure. Nocturnal worsening of asthma is a common manifestation of this disease that indicates increased disease severity. Therapy focuses on judicious use of long-acting bronchodilators, and the presence of OSA should also be considered. COPD is frequently associated with impaired sleep, likely because of chronic dyspnea and sleep-associated hypoxemia. Appropriate therapy again includes long-acting bronchodilators and possibly nocturnal supplemental oxygen. Gastroesophageal reflux during sleep may lead to prolonged episodes of esophageal acid exposure and may be a common sequela of OSA, perhaps triggering nocturnal worsening of asthma. Endstage renal disease and chronic dialysis are commonly associated with a host of troublesome sleep problems,including OSA, RLS, PLMD, and daytime sleepiness.
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PMID:Sleep and medical disorders. 1593 98

Chronic cough with established diagnostic protocols has been well described in secondary and tertiary centres. Little information is available about adult patients to a general respiratory clinic where no such protocols exist. The objective of this study is to determine clinical characteristics, laboratory findings, diagnostic spectrum and outcomes of specific therapy in adult patients with chronic cough in a general respiratory clinic. In this prospective, longitudinal, descriptive study for patients with chronic cough defined as more than 8 weeks, we studied, according to a questionnaire, chest radiography, spirometry and reversibility, methacholine challenge and other measures. Treatment was prescribed on the basis of diagnosis informed by investigation results.We evaluated 147 patients (102 females) of a mean age of 48 years and complaining of cough an average of 24 weeks. On the basis of a successful response to treatment, the causes of cough were determined in 92% and the frequencies were asthma in 39%, COPD in 11%, chronic upper airway cough syndrome (CUACS) in 9%, gastro-oesophageal reflux disease (GERD) in 9% and no diagnosis in 8%. Cough was due to one condition in 82%. Our treatment success rate was 92%. The most frequent causes of chronic cough (asthma, COPD, CUACS and GERD) could be determined in a general respiratory clinic with a sequential approach. The frequencies are different from those in a tertiary cough clinic, but outcome of specific therapy is successful in our patients.
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PMID:A prospective longitudinal study of clinical characteristics, laboratory findings, diagnostic spectrum and outcomes of specific therapy in adult patients with chronic cough in a general respiratory clinic. 1685 53

The purpose of this study was to identify determinants of asthma control. Questionnaires were completed by a random sample of 570 members of a large managed care organization who were >or=35 years of age with utilization suggestive of active asthma. Asthma control was assessed buy the Asthma Control Test (ACT). Independent relationships were found between lower ACT scores and oral corticosteroid use (p < 0.0001), COPD (p < 0.0001), absence of regular specialist care (p = 0.006), higher BMI (p = 0.01), gastroesophageal reflux (p = 0.02), not being Caucasian (p = 0.04), and low income (p = 0.04).
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PMID:Predictors of asthma control in a random sample of asthmatic patients. 1753 May 35

Collecting exhaled breath condensate (EBC) has become a frequently used method in respiratory researches to date. Through this method we can sample airway surface liquid non-invasively by streaming the exhaled breath through a cooled chamber and after we examine the fluid deposited on the wall of the condenser. The sample contains several mediators, biomarkers. The pH of the condensate is one of the most important markers measured in the EBC. Measuring the pH is easy, cheap and it is in the optimal range, there is no problem with the detection limit. The uncertainty of the pH assays is derived from the instability of the EBC pH which results from the altering carbon-dioxide concentration. Many articles have been published on EBC pH in different airway diseases. Acidification of the condensates has been described in bronchial asthma (especially in acute exacerbations), chronic obstructive lung disease (COPD). Due to the steroid treatment the pH has increased in both cases. In patients with bronchiectasis, cystic fibrosis and in chronic cough (bronchial asthma, gastro-esophageal reflux, postnasal drip, and unknown origin) the pH of EBC was also lower. Acidification of the airways in different diseases can play a role in the pathomechanism, and its indicator, the EBC pH might help managing patients with airway diseases.
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PMID:[The pH of the exhaled breath condensate: new method for investigation of inflammatory airway diseases]. 1758 55

Cough is a common presenting symptom of many patients managed by allergists. For patients with chronic cough who are nonsmokers, have normal spirometry, and are not being treated with an ACE inhibitor, diagnosis usually focuses on differentiation between postnasal drip syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis, alone or in combination. Patients with severe COPD or GERD should be referred to appropriate specialists for those conditions. The management of conditions commonly treated by allergists (e.g., allergic rhinitis, asthma, sinusitis) follows the recommendations of current guidelines and/or practice parameters.
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PMID:Chronic cough: the allergist's perspective. 1795 6


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