O7.5 Gastro-oesophageal reflux

In patients with COPD, hyperinflation, coughing and the increased negative intrathoracic pressures of inspiration may predispose to reflux, especially during recumbency and sleep. In a prospective cohort study, gastro-oesophageal reflux symptoms were associated with an increased risk of exacerbation. (Terada et al., 2008) A nested case control study performed on a large primary care dataset found a modest increased risk of a diagnosis of gastro-oesophageal reflux in patients with a pre-existing diagnosis of COPD (RR 1.46 CI 1.19-1.78). (Garcia Rodriguez et al., 2008) Microaspiration of oesophageal secretions (possibly including refluxed gastric content) is a risk, especially with coexistent snoring or OSA. Reflux and microaspiration exacerbate cough, bronchial inflammation and airway nar­rowing.

Diagnosis may be confirmed by 24-hour monitoring of oesophageal pH, modified barium swallow or gastroscopy. However, a therapeutic trial of therapy with H₂-receptor antagonists or a proton-pump inhibitor may obviate the need for invasive investigations. Lifestyle changes, including stopping smoking, limiting food intake within 4 hours of bed-time, reduced intake of caffeine and alcohol, weight loss and exercise, will also help. Elevation of the head of the bed is also recommended.

Randomised controlled trials of these interventions are required.