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Reflux-Aspiration in Chronic Lung Disease.
Augustine S Lee1, Joyce S Lee2, Zhaoping He3
1Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida.
Annals of the American Thoracic Society
|November 8, 2019
Summary
Microaspiration, or silent aspiration, is often suspected in respiratory conditions due to gastroesophageal reflux. However, evidence suggests it may be a secondary factor or not significant in many cases, requiring careful diagnosis before treatment.
Area of Science:
- Pulmonology
- Gastroenterology
- Pathophysiology
Background:
- Microaspiration is frequently suspected in refractory respiratory symptoms like chronic cough, asthma, COPD, and IPF.
- This suspicion stems from the high prevalence of gastroesophageal reflux (GERD) in these conditions.
- Aggressive GERD treatment is common for respiratory issues, despite limited evidence of efficacy and potential harm.
Purpose of the Study:
- To review the evidence linking reflux-aspiration to chronic respiratory disorders.
- To differentiate between direct causation and indirect aggravation by microaspiration.
- To offer management considerations for suspected reflux-aspiration.
Main Methods:
- Clinical review of existing literature and studies.
- Examination of mechanistic studies using gastric biomarkers in airways.
- Consideration of histopathologic evidence of foreign bodies.
Main Results:
- Clinical trials lack clear outcome improvements for GERD treatment in respiratory patients.
- Biomarker studies show correlation but are limited by methodological flaws.
- Histopathology provides the strongest evidence for aspiration causing respiratory issues.
- Microaspiration may be uncommon or a secondary factor in COPD and IPF exacerbations.
- Microaspiration is likely insignificant in unexplained chronic cough.
Conclusions:
- Distinguishing direct causation from indirect aggravation by microaspiration is crucial.
- Management strategies should be tailored based on the role of aspiration.
- Further research is needed to clarify the precise role of microaspiration in various respiratory diseases.
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