Association Between Chronic Obstructive Pulmonary Disease and Gastroesophageal Reflux Disease

A National Cross-sectional Cohort Study

Jinhee Kim; Jin Hwa Lee; Yuri Kim; Kyungjoo Kim; Yeon-Mok Oh; Kwang Ha Yoo; Chin Kook Rhee; Hyoung Kyu Yoon; Young Sam Kim; Yong Bum Park; Sei Won Lee; Sang Do Lee


BMC Pulm Med. 2013;13(51) 

In This Article


Exacerbations of chronic obstructive pulmonary disease (COPD) have a significant impact on patient quality of life and can accelerate lung function decline,[1] which is associated with increased morbidity and mortality.[2,3] Gastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough[4] and a potential risk factor for exacerbation of COPD.[5–7] GERD is a relatively common condition, affecting 10–29% of the western population[8] and 3–12% of Korean adults.[9] GER can heighten bronchial reactivity and microaspiration.[10–13] Abnormal GER was objectively assessed and clearly associated to lung diseases.[14,15] Laryngopharyngeal sensitivity is important in preventing pulmonary aspiration. Patients with cough and GERD have significantly reduced laryngopharyngeal sensitivity to air stimuli compared with healthy subjects.[16] COPD patients have flat diaphragm and increased intra-abdominal and negative intra-thoracic pressure, which could aggravate GER.[17] In addition, medications such as theophylline and inhaled beta-2 agonists may decrease the lower esophageal sphincter pressure, could facilitate GER.[18,19] Therefore several small studies showed that GERD is more common in patients with COPD than that in those without COPD.[20–22] Also it has been suggested that an increase in the frequency of COPD exacerbation can be associated with the presence of GERD.[6,7,23,24]

We used the National Health Insurance Database of Korea and tried to answer three questions. First question was the prevalence of GERD in patients with COPD. Second one was which factors are associated with GERD in COPD patients. Third was whether the presence of GERD is associated with exacerbation of COPD even after adjusting confounding factors.