Relationship Between Gastroesophageal Reflux Disease and COPD in UK Primary Care

Luis A. García Rodríguez, MD; Ana Ruigómez, MD, PhD; Elisa Martín-Merino, BPharm; Saga Johansson, MD, PhD; and Mari-Ann Wallander, PhD

Disclosures

CHEST. 2008;134(6):1123-1230. 

In This Article

Abstract and Introduction

Abstract

Background: Gastroesophageal reflux symptoms may be more common in patients with COPD than in control subjects. The aim of this study was to investigate the relationship between diagnoses of COPD and gastroesophageal reflux disease (GERD) in primary care.
Methods: We used the UK General Practice Research Database to identify a cohort of patients with a first diagnosis of GERD (n = 4,391) and another cohort of patients with a first diagnosis of COPD (n = 1,628) during 1996, which we compared with age-matched and sex-matched comparison cohorts without either diagnosis. We calculated the incidence of a GERD diagnosis among the patients with COPD and control subjects, and of a COPD diagnosis among the patients with GERD and control subjects. We also calculated the relative risk (RR) estimates of these diagnoses using the Mantel-Haenszel test. Risks associated with medication use, comorbidities, and demographic and lifestyle factors were examined using a nested case-control analysis.
Results: During the 5-year follow-up, the RR of an incident COPD diagnosis in patients with a diagnosis of GERD was 1.17 (95% confidence interval [CI], 0.91 to 1.49), while the RR of an incident GERD diagnosis among patients with a diagnosis of COPD was 1.46 (95% CI, 1.19 to 1.78). A COPD diagnosis was associated with current or former smoking, prior diagnosis of asthma, or the use of asthma medication. A GERD diagnosis was associated with a prior diagnosis of ischemic heart disease.
Conclusions: Patients with a diagnosis of COPD are at a significantly increased risk of a diagnosis of GERD compared with individuals with no COPD diagnosis.

Abstract and Introduction

Introduction

Gastroesophageal reflux disease (GERD) is a common GI disease that has recently been defined, by the Montréal definition, as "a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications."[1] The Montréal definition identified a number of extraesophageal syndromes that are associated with GERD. These include reflux cough and reflux asthma syndromes.

Several small studies[2,3,4] have also suggested that gastroesophageal reflux symptoms are more common in patients with COPD than in those without the condition. COPD is characterized by airflow limitation that is not fully reversible by β2-agonist agents.[5] This airflow limitation is typically progressive and is associated with an abnormal inflammatory response in the lungs.[6] Patients with COPD experience acute exacerbations of the disease, which are a major cause of morbidity and mortality. These are characterized by the presence of worsening dyspnea, increased sputum production, and the development of purulent sputum.[7]

It has also been suggested that an increase in the frequency of COPD exacerbations can be associated with the presence of GERD.[8,9] However, little is known about the temporal relationship between the two diseases. We have previously shown that a diagnosis of COPD is associated with an increased likelihood of a subsequent diagnosis of GERD,[10] but the reverse relationship has not been investigated.

In the current study, we sought to explore further the relationship between COPD and GERD that are diagnosed in the primary care setting, and to identify patient characteristics that are associated with diagnoses of these two diseases. We conducted two longitudinal cohort studies to investigate this relationship in UK primary care using the General Practice Research Database (GPRD).

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