Pharmacological and surgical interventions for the treatment of gastro-oesophageal reflux in adults and children with asthma.

摘要: BACKGROUND Asthma and gastro-oesophageal reflux disease (GORD) are common medical conditions that frequently co-exist. GORD has been postulated as a trigger for asthma; however, evidence remains conflicting. Proposed mechanisms by which causes asthma include direct airway irritation from micro-aspiration vagally mediated oesophagobronchial reflux. Furthermore, might precipitate GORD. Thus temporal association between the two does not establish triggers asthma. OBJECTIVES To evaluate effectiveness of treatment in adults children with asthma, terms its benefits SEARCH METHODS The Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, Embase, reference lists articles, online clinical trial databases were searched. most recent search was conducted on 23 June 2020. SELECTION CRITERIA We included randomised controlled trials comparing diagnosis both versus no or placebo. DATA COLLECTION AND ANALYSIS A combination independent review authors extracted study data assessed quality. primary outcome interest this acute exacerbation reported trialists. MAIN RESULTS systematic yielded total 3354 citations; studies (n = 2872 participants) suitable inclusion. Included participants 25 different countries across Europe, North South America, Asia, Australia, Middle East. Participants had moderate to severe predominantly presenting clinic treatment. Only effects intervention children, impact surgical intervention. remainder concerned using variety dosing protocols. There an uncertain reduction number experiencing one more moderate/severe exacerbations (odds ratio 0.53, 95% confidence interval (CI) 0.17 1.63; 1168 participants, 2 studies; low-certainty evidence). None related other outcomes review: hospital admissions, emergency department visits, unscheduled doctor visits. Medical probably improved forced expiratory volume second (FEV₁) small amount (mean difference (MD) 0.10 L, CI 0.05 0.15; 1333 7 moderate-certainty evidence) well use rescue medications (MD -0.71 puffs per day, -1.20 -0.22; 239 However, benefit morning peak flow rate 6.02 L/min, 0.56 11.47; 1262 5 studies). It is important note these mean improvements did reach importance. synthesised narratively including symptoms, quality life, preference likewise uncertain. Data adverse events generally underreported studies, those available indicated similar rates regardless allocation AUTHORS' CONCLUSIONS Effects people utilisation remain may provide secondary management. This determined certainty treatment, lung function measures slightly, control reduced. Further, insufficient assess results compare surgery therapy.