Department of Respiratory and Critical Care Medicine, Affiliated People's Hospital to Ningbo University, Yinzhou People's Hospital, Ningbo City, P.R. China.
Clin Respir J. 2021 May;15(5):558-567. doi: 10.1111/crj.13347. Epub 2021 Mar 15.
Chronic obstructive pulmonary disease (COPD) patients have higher laryngopharyngeal reflux (LPR)-related symptom incidence. But LPR treatment is empirical. We aimed to determine the frequency of LPR, diagnosed by 24-hour Dx-pH monitoring, among acute exacerbations of COPD (AECOPD) patients with Reflux Symptom Index (RSI) ≥13 and investigate proton pump inhibitor (PPI) treatment effect on LPR, COPD symptoms, and pulmonary function.
From January 2016 to September 2017, 102 AECOPD patients with RSI ≥13 were enrolled. COPD assessment test (CAT), mMRC dyspnea scale, pulmonary function tests, and 24-hour Dx-pH monitoring were performed. The Ryan score was evaluated by using the Dx-pH DataView Lite software, which identifies patients with abnormal pharyngeal pH environments. Associations among RSI, pulmonary function test results, and Ryan score parameters were evaluated. The abovementioned assessments were reperformed after treatment, and pre- and posttreatment data were compared.
Of the 102 eligible patients, 49 (48.04%) were diagnosed with LPR based on Ryan score. Percentage of the forced expiratory volume at 1 second (FEV1%) was significantly worse in Ryan-positive than in Ryan-negative AECOPD patients. There were significant negative correlations between FEV1% and Ryan score (r = -0.394, P < 0.001), FEV1% and % time below pH threshold (r = -0.371, P < 0.001) in upright position but not in supine position. There was no significant correlation between RSI and Ryan score parameters. There were significant improvements in RSI, mMRC, CAT, and FEV1% in Ryan-positive AECOPD patients after PPI and basic treatments.
Study results indicate unreliability of RSI threshold for LPR diagnosis. Combination of symptoms, endoscopic findings, and 24-hour Dx-pH monitoring is recommended for LPR diagnosis and PPI treatment decisions, especially in difficult-to-control or severe COPD patients.
慢性阻塞性肺疾病（COPD）患者的咽喉反流（LPR）相关症状发生率较高。但 LPR 的治疗是经验性的。我们旨在确定通过 24 小时 Dx-pH 监测诊断的 LPR 在反流症状指数（RSI）≥13 的 COPD 急性加重（AECOPD）患者中的频率，并研究质子泵抑制剂（PPI）对 LPR、COPD 症状和肺功能的治疗效果。
2016 年 1 月至 2017 年 9 月，纳入 102 例 RSI≥13 的 AECOPD 患者。进行 COPD 评估测试（CAT）、mMRC 呼吸困难量表、肺功能检查和 24 小时 Dx-pH 监测。使用 Dx-pH DataView Lite 软件评估 Ryan 评分，该软件可识别存在异常咽 pH 环境的患者。评估 RSI、肺功能检查结果和 Ryan 评分参数之间的相关性。治疗后重复上述评估，并比较治疗前后的数据。
在 102 名符合条件的患者中，根据 Ryan 评分，49 名（48.04%）患者被诊断为 LPR。Ryan 阳性的 AECOPD 患者的 1 秒用力呼气量（FEV1%）明显更差。Ryan 阳性的 AECOPD 患者的 FEV1%与 Ryan 评分呈显著负相关（r=-0.394，P<0.001），FEV1%与直立位时 pH 阈值以下时间的百分比呈显著负相关（r=-0.371，P<0.001），但在仰卧位时无显著相关性。RSI 与 Ryan 评分参数之间无显著相关性。Ryan 阳性的 AECOPD 患者在接受 PPI 和基础治疗后，RSI、mMRC、CAT 和 FEV1%均有显著改善。
研究结果表明 RSI 阈值用于诊断 LPR 不可靠。建议对 LPR 诊断和 PPI 治疗决策采用症状、内镜检查结果和 24 小时 Dx-pH 监测相结合的方法，尤其是在难以控制或严重的 COPD 患者中。
