Gastro‐esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease

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Abstract
Background and objective: We tested the hypothesis that gastro‐esophageal reflux disease is a risk factor for exacerbations in individuals with chronic obstructive pulmonary disease (COPD).Methods: Among 9622 participants in the Copenhagen City Heart Study, we identified 1259 individuals with COPD and information on gastro‐esophageal reflux disease and the regular use of acid inhibitory treatment. These individuals were followed for 5 years with regard to medically treated COPD exacerbations, which we defined as a short course treatment with oral corticosteroids alone or in combination with antibiotics. We applied a multivariable Cox regression analysis with adjustment for well‐established risk factors associated with COPD exacerbations or gastro‐esophageal reflux disease, including COPD severity, and symptoms.Results: Individuals with COPD and gastro‐esophageal reflux disease had more chronic bronchitis (31 vs 21%, P = 0.004), more breathlessness (39 vs 22%, P < 0.001), and more of them had a history of respiratory infections (6.8 vs 1.4%, P < 0.001) than individuals with COPD but without gastro‐esophageal reflux disease. Among individuals with COPD and gastro‐esophageal reflux disease, those who did not use acid inhibitory treatment regularly had an increased risk of COPD exacerbations during follow‐up, hazards ratio (HR): HR = 2.7 (1.3–5.4, P = 0.006). Individuals with gastro‐esophageal reflux disease, using acid inhibitory treatment regularly did not have an increased risk of exacerbations, HR = 1.2 (0.6–2.7, P = 0.63).Conclusions: Gastro‐esophageal reflux disease was associated with an increased risk of medically treated exacerbations of COPD, but only in those individuals who did not use acid inhibitory treatment regularly.

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