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Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study

Show simple item record Amarasiri, D.L. en_US Pathmeswaran, A. en_US de Silva, H.J. en_US Ranasinha, C.D. en_US 2014-10-29T09:40:14Z 2014-10-29T09:40:14Z 2013 en_US
dc.identifier.citation BMC Pulmonary Medicine. 2013; 13(1): 33 en_US
dc.identifier.issn 1471-2466 (Electronic) en_US
dc.description Indexed in Scopus; MEDLINE en
dc.description.abstract BACKGROUND: Gastro-esophageal reflux disease (GERD) predisposes to airway disease through a vagally-mediated esophago-bronchial reflex. This study investigates this vagal response to esophageal acid perfusion. METHODS: 40 asthmatics with mild stable asthma participated. Each subject underwent spirometry and autonomic function testing (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) four times: a) before intubation, b) after intubation, and then immediately after perfusion with, in random order, c) concentrated lime juice solution (pH 2--3) and d) 0.9% saline. Subjects were blinded to the solution perfused. RESULTS: Asthmatics were of mean (SD) age 34.3 years (1.3), and 67.5% of them were females. pH monitoring demonstrated that 20 subjects had abnormal reflux and 20 did not. In each group 10 subjects had a positive GERD symptom score. Following perfusion with acidcompared to saline, all subjects showed significant decreases in FEV1 and PEFR and significant increases in the mean valsalva ratio and heart rate difference on deep breathing from baseline values, but no changes in FVC or heart rate ratio on standing. There were no significant differences in any of the parameters between subjects with and without reflux. CONCLUSIONS: Acid stimulation of the distal esophagus results in increased parasympathetic activity and concomitant broncho-constriction in asthmatics irrespective of their reflux state. This strengthens the hypothesis that GER triggers asthma-like symptoms through a vagally mediated esophago-bronchial reflex and encourages a possible role for anti-cholinergic drugs in the treatment of reflux-associated asthma
dc.publisher BioMed Central en_US
dc.title Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study en_US
dc.type Article en_US
dc.identifier.department Physiology en_US
dc.identifier.department Public Health en_US
dc.identifier.department Medicine en_US
dc.identifier.department Pharmacology en_US

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