Do GERD and asthma represent one-two punch for children?

Children with gastro-oesophageal reflux disease (GERD) are at heightened risk of developing asthma, and those with asthma are prone to develop GERD, according to a study, which suggests that the two conditions have a bidirectional relationship.

The study used data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort and included two patient cohorts of children aged <15 years: 86,096 asthmatic patients and 86,096 matched controls (cohort 1), and 532 GERD patients and 1,064 matched controls (cohort 2).

In cohort 1, more patients in the asthma than in the control group developed GERD (0.7 percent vs 0.5 percent; p<0.001). The mean time to GERD diagnosis was 76.9 months in the asthma group and 77.4 months in the control 1 group.

Cox proportional hazards regression showed that in the presence of asthma, the risk of incident GERD increased by 36 percent (hazard ratio [HR], 1.36, 95 percent confidence interval [CI], 1.20–1.54; p<0.001). Results were consistent in subgroups defined by age and sex.

Likewise, in cohort 2, significantly more children with GERD developed asthma compared with controls (15.0 percent vs 10.0 percent; p<0.001). The mean time to asthma diagnosis was 28.3 months in the GERD group and 22.3 months in the control group.

GERD was associated with a 62-percent increased risk of developing asthma (HR, 1.62, 95 percent CI, 1.21–2.18; p=0.001). The risk increase was observed in all GERD subgroups except for children aged 5–9 years and boys.

Researchers cited evidence from prior studies suggesting that GERD could increase the risk of asthma via reflux-induced airway damage and inflammation, whereas asthma might lead to subsequent GERD through systemic inflammation or the vagal reflex. [Respir Med 2018;143:42-47; Respir Med 2006;100:307-315; Am J Med 2001;111(Suppl 8A):13S-17SS]

Given that the study could not count subclinical cases/underdiagnosed/and untreated asthma or GERD and did not include data on asthma types and possible comorbidities, the researchers urged consideration of the present limitations in future investigations on the causality of the relationship between asthma and GERD.