Exhaled breath condensate pepsin and pH: noninvasive tests for gastroesophageal reflux in acute exacerbations of chronic obstructive pulmonary disease

Abstract

Introduction Gastroesophageal reflux disease (GERD) has been shown to worsen chronic obstructive pulmonary disease (COPD) control through esophagobronchial reflex and to heighten bronchial reactivity and microaspiration. Exhaled breath condensate (EBC) is an exciting technology that allows an insight into biomolecules of airway lining fluid. Furthermore, diagnosis of GERD in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by EBC pepsin and pH levels is fast and easy. Patients and methods A total of 50 individuals were included in this study. They were divided into three groups: group A included 20 patients diagnosed with AECOPD and GERD, group B included 20 patients with GERD with chronic cough, and group C (control group) included 10 healthy participants to determine the natural level of pepsin in EBC. EBC pepsin concentration as well as pH was measured among all groups. Reflux symptom index (RSI) was also measured as a tool for GERD diagnosis. Results Patients with AECOPD had increased levels of pepsin in their EBC samples and lower pH level than the other two groups. RSI was significantly higher among patients with COPD with GERD than either GERD patients or healthy controls. Significant associations existed between EBC pepsin and RSI and EBC pH among the COPD group. Conclusion Measurement of EBC pepsin and pH in patients with AECOPD may represent a diagnostic and noninvasive test for GERD among those patients.

Keywords

• acute exacerbations of chronic obstructive pulmonary disease
• exhaled breath condensate
• gastroesophageal reflux disease