Research Day

Document Type





In uncontrolled asthma, comorbid conditions should be treated in order to achieve better asthma control. The contribution of gastro-esophageal reflux (GER) may be overlooked when its presentation is atypical. 
Case Report: 
11 year-old male with moderate persistent asthma and allergic rhinitis presented with persistent barky cough, diagnosed as spasmodic croup after bronchoscopy, esophagram, swallow study and magnified airway x-ray failed to show anatomical abnormality. Empiric proton pump inhibitor (PPI) treatment was started with improvement in cough. Patient was referred to Gastroenterology for evaluation of GER, despite lack of heartburn or vomiting. Endoscopy revealed esophageal candida infection which was treated. The cough however, was felt to be secondary to allergic rhinitis and reactive airway disease, thus PPI was discontinued. Impedance, pH probe or esophageal manometry were not performed. Off of PPI, patient developed frequent dyspnea, wheezing, increased requirement for albuterol and systemic corticosteroids. Bronchoscopy revealed edematous, friable, hyper-reactive airway mucosa, with negative bacteria and fungi cultures. PPI was re-started with significant decrease in wheezing, dyspnea and cough. 
Uncontrolled allergic rhinitis, sinus disease and traditionally presenting GER are accepted comorbid conditions leading to poor asthma control. Empiric treatment of “silent GER” has remained a controversial issue. GER is a risk factor for increased severity of chronic rhinosinusitis and asthma. An association exists between neutrophilic asthma, chronic rhinosinusitis and GERD. History of GERD is among strongest predictive factors for early asthma readmissions. Atypical GER presentation should not deter consideration for treatment. 
This case illustrates importance of treating GERD in uncontrolled asthma, even without traditional gastro-esophageal symptoms.



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