Medicine of the Future in America

The Relation Between Gastroesophageal Reflux and Respiratory Symptoms in a Population-Based Study: Study Participants

Of the 65,363 individuals participating in the HUNT-2 survey, 58,596 persons (89.6%) answered the questions regarding reflux symptoms. Of these, 40,210 persons (68.6%) had no reflux symptoms and thus represented the control group, whereas the 3,153 persons (5.4%) with severe reflux symptoms constituted the case group. Table 1 outlines some characteristics of the study participants. The mean ages of the case and control participants were 52 years and 48 years, respectively. The proportion of men was slightly higher in the case group (49%) than in the control group (47%). Case participants were more likely to be overweight (BMI > 25) and to have smoked for > 1 year compared to the control persons, while the distribution of alcohol consumption was similar between the groups (Table 1). Link

Strong statistically significant associations between a number of respiratory symptoms and reflux symptoms were found (Table 2). The occurrence of any of the respiratory symptoms listed in Table 2 was almost three times more common among the persons with reflux symptoms than among the control persons. The multivariable analysis revealed that the persons with asthma had reflux symptoms twice as often as those without asthma (OR, 2.0; 95% CI, 1.8 to 2.2), and this association remained after adjustment for use of asthma medication (OR, 1.6; 95% CI, 1.4 to 1.9). Persons with heavy and wheezy breathing, daily cough, daily productive cough, or chronic cough (daily productive cough for > 3 months during the past 2 years) showed a statistically significantly twofold to threefold increase in the risk of reflux symptoms (Table 2). Furthermore, breathlessness showed a significant dose-response association with reflux symptoms (p for trend < 0.0001). The OR of reflux symptoms was 12.0 (95% CI, 9.5 to 15.2) among persons with severe breathlessness compared to those without such symptoms. The occurrence of asthma or the use of asthma medication did not substantially influence the risk estimates for any of the studied respiratory disorders, indicating a lack of strong confounding by these covariates (Table 2).

Table 1—Characteristics of the Case Participants With Reflux Symptoms and Control Participants Without Reflux Symptoms

Characteristics Case Participants Control Participants Total
Sex
Men 1,555 (49.3) 18,814 (46.8) 20,369 (47.0)
Women 1,598 (50.7) 21,396 (53.2) 22,994 (53.0)
Total 3,153 (100.0) 40,210 (100.0) 43,363 (100.0)
Age, yr Median 51.0 46.0 46.0
Range 19-101 19-99 19-101
Tobacco smoking (years of daily smoking) < 1 1,253 (39.7) 20,414 (50.8) 21,667 (50.0)
1-10 384 (12.2) 5,204 (12.9) 5,588 (12.9)
> 10 1,516 (48.1) 14,592 (36.3) 16,108 (37.2)
Alcohol consumption! None 1,066 (54.2) 11,960 (51.2) 13,026 (51.5)
1-4 776 (39.5) 10,029 (43.0) 10,805 (42.7)
5-10 58 (3.0) 695 (3.0) 753 (3.0)
> 10 67 (3.4) 655 (2.8) 722 (2.9)
BMI, kg/m2 < 25 753 (23.9) 18,356 (45.7) 19,109 (44.1)
25-30 1,546 (49.0) 16,675 (41.5) 18,221 (42.0)
30-35 646 (20.5) 4,194(10.4) 4,840(11.2)
> 35 208 (6.6) 985 (2.5) 1,193 (2.8)

Table 2—Respiratory Disorders and Reflux Symptoms

Variables CaseParticipants ControlParticipants Adjusted for Age and Sex Multivariable Modelf
OR 95% CI OR 95% CI
Breathlessness
No 1,947 (78.3) 37,607 (94.6) 1.0 Reference 1.0 Reference
Minor symptoms 402 (16.2) 1,971 (5.0) 3.9 3.5-4.4 3.5 3.1-4.0
Severe symptoms 138 (5.5) 196 (0.5) 13.3 10.6-16.6 12.0 9.5-15.2
p Value for linear trend < 0.0001 < 0.0001
Daily cough
No 2,308 (73.4) 35,260 (87.9) 1.0 Reference 1.0 Reference
Yes 836 (26.6) 4,874(12.1) 2.6 2.4-2.8 2.4 2.2-2.6
Productive cough
No 508 (52.2) 4,509 (63.9) 1.0 Reference 1.0 Reference
Yes 465 (47.8) 2,551 (36.1) 1.9 1.7-2.2 1.9 1.6-2.1
Chronic coughj
No 712 (74.6) 6,259 (86.6) 1.0 Reference 1.0 Reference
Yes 242 (25.4) 970(13.4) 2.1 1.8-2.5 2.0 1.7-2.4
Heavy breathing with wheezing
No 2,350 (75.8) 36,080(91.1) 1.0 Reference 1.0 Reference
Yes 750 (24.2) 3,541 (8.9) 3.2 2.9-3.5 2.8 2.5-3.1
Asthma
No 2,733 (86.7) 37,270 (92.7) 1.0 Reference 1.0 Reference
Yes 420 (13.3) 2,940 (7.3) 2.0 1.8-2.2 1.6 1.4-1.9
All respiratory symptoms including asthma
No 1,724 (54.7) 31,416(78.1) 1.0 Reference 1.0 Reference
Yes 1,429 (45.3) 8,794(21.9) 2.9 2.7-3.2 2.7 2.5-3.0
Months of asthma medication for the last 12 mo§
No asthma medication 2,948 (93.5) 38,974 (96.9) 1.0 Reference 1.0 Reference
1-6 mo 71 (2.3) 481 (1.2) 2.0 1.5-2.5 1.7 1.3-2.2
7-12 mo 134 (4.3) 755 (1.9) 2.2 1.8-2.7 2.0 1.7-2.4
This entry was posted in Pulmonary function and tagged asthma, Epidemiology, gastroesophageal reflux, respiratory symptoms.
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