As we come together this month to celebrate National COPD Awareness and World COPD Day, it’s worth remembering the complexities that COPD (Chronic Obstructive Pulmonary Disorder) can bring to other diagnoses, especially GERD (Gastro-Esophageal Reflux Disease) and LPR (Laryngo-Pharyngeal Reflux).
A 2016 study on GERD and COPD showed that with a symptom based diagnosis alone, PPI prescriptions for GERD patients were not reliable in the control and resolution of those symptoms. Worse yet, their findings suggest that “patients with stable COPD receiving acid-suppressive therapy with PPIs remain at high risk of frequent and severe exacerbations.”
While the study did not assess the effectiveness of non-medicative reflux treatments, such as Stretta, it effectively highlights the lack of clarity in current diagnostic standards. Many common GERD and LPR symptoms such as chronic cough, throat clearing, shortness of breath, and wheezing are also associated with COPD, leading to difficulties in diagnosing and treating the multifaceted disease state.
In 2017, a team led by Prof. Diaina Stolz of the University of Basel, showed that patients with COPD and LPR could be effectively treated once properly diagnosed with an objective test, the Restech Dx-pH sensor for LPR. Their research, published in the European Respiratory Journal, concluded:
“Laryngopharyngeal reflux cannot be diagnosed from symptoms only; is more common in patients with COPD; and can be reduced by PPI therapy.”
In this study, 203 subjects were separated into 3 groups:
- 107 ambulatory patients with COPD, no other respiratory illnesses (COPD_1)
- 86 hospitalized patients with COPD + other respiratory illnesses (COPD_2)
- 11 healthy controls
Restech’s proprietary RYAN score (developed by Dr. Tom DeMeester) was used to evaluate the presence of LPR. RYAN score ≥ 9.4 (pH <5.5) in an upright position was considered pathologic. See the results below in Table 1.
Table 1: RYAN Score in COPD_1, COPD_2, and Healthy Subjects
|Group & Description||Avg RYAN score||% pts w/pathologic RYAN score (LPR)||OR, p-value|
|COPD_1 (ambulatory patients with COPD, no other respiratory illnesses); n=107||234||67%||(OR=9.26; p=0.006)|
|COPD_2 (hospitalized patients with COPD in addition to other respiratory illnesses); n=86||147||58%||(OR=6.25; p=0.024)|
Patients in the COPD_1 group had a significantly higher RYAN score than both the COPD_2 group (p= 0.018) and healthy controls (p=0.002).
“Overall, having COPD significantly increased the risk of having an abnormal RYAN score (or LPR) even after adjusting for age (OR=5.604; p=0.035).”
While the RYAN Score is only a measurement for the most severe LPR and future research will help to identify how mild and moderate LPR can affect COPD, this finding brings an increased understanding to physicians treating those suffering from COPD. A definitive diagnosis and new treatment options such as Stretta, will undoubtedly lead to improved quality of life for COPD patients and a brighter future for those with this condition.