The effects of GERD dyspepsia and rhinosinusitis on asthma

Tamotsu Ishizuka,^1,2 Takeshi Hisada,² Yosuke Kamide,² Haruka Aoki,² Kaori Seki,² Chisato Honjo,¹ Hiroyuki Sakai,¹ Maiko Kadowaki,¹ Yukihiro Umeda,¹ Miwa Morikawa,¹ Masaki Anzai,¹Shingo Ameshima,¹ Takeshi Ishizaki,¹ Kunio Dobashi,² Masanobu Yamada,² Motoyasu Kusano^3
1Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui,²Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, ³Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Maebashi, Japan


Background: Losing the sense of smell, which suggests eosinophilic rhinosinusitis, is a subjective symptom, sometimes reported in asthmatic patients taking controller medication. Upper abdominal symptoms, suggesting gastroesophageal reflux disease (GERD) or functional dyspepsia, occur also in these patients. However, the relationship between these symptoms, concomitant with asthma, and the intensity of eosinophilic airway inflammation remains obscure.
Objective: To assess the symptoms of asthma and rhinosinusitis, and to examine the relationship between the symptoms and bronchial inflammation, a new questionnaire, the G scale, was developed. To investigate the effects of GERD, dyspepsia, and rhinosinusitis on asthma symptoms and bronchial inflammation, the symptoms of asthma and rhinosinusitis obtained by the G scale, upper abdominal symptoms obtained by the modified F scale, a questionnaire for GERD and dyspepsia, and fractional exhaled nitric oxide (FeNO) were analyzed.
Methods: A prospective, observational study was performed in four hospitals in Gunma prefecture, and a retrospective analysis was done using data obtained from five hospitals in Gunma prefecture and Fukui prefecture, Japan. A total of 252 patients diagnosed as having asthma participated in the prospective study.
Results: The frequency of daytime phlegm or losing the sense of smell had a positive correlation with FeNO levels in asthmatic patients taking controller medication. Upper abdominal symptoms, as well as symptoms suggesting rhinitis, were well correlated with asthma symptoms. However, neither upper abdominal symptoms nor rhinitis symptoms increased FeNO levels, which reflect eosinophilic airway inflammation during treatment for asthma. On the other hand, the degree of upper abdominal symptoms or dyspepsia symptoms had a weak but significant negative correlation with FeNO levels.
Conclusion: Daytime phlegm and losing the sense of smell suggest that eosinophilic airway inflammation persists, despite anti-inflammatory therapy, in patients with asthma. Although rhinitis and GERD made the subjective symptoms of asthma worse, they did not seem to enhance eosinophilic airway inflammation.

Keywords: asthma symptoms, FeNO, rhinosinusitis, GERD, dyspepsia

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Authors Ishizuka T, Hisada T, Kamide Y, Aoki H, Seki K, Honjo C, Sakai H, Kadowaki M, Umeda Y, Morikawa M, Anzai M, Ameshima S, Ishizaki T, Dobashi K, Yamada M, Kusano M

Published Date September 2014 Volume 2014:7 Pages 131—139

DOI http://dx.doi.org/10.2147/JAA.S67062 Received 30 April 2014, Accepted 30 June 2014, Published 5 September 2014

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