Figure 1. Higher prevalence of significant GER symptoms in patients with COPD. The prevalence of significant GER symptoms (heartburn and/or regurgitation once or more per week), chronic cough, and dysphagia in patients with COPD (gray bars) are compared to control subjects (open bars). GER symptoms were assessed by a modified version of the Mayo Clinic GER questionnaire (see "Materials and Methods" section). *p < 0.05 COPD patients vs control subjects. Percent (%) * * *

Figure 2. Higher prevalence of significant GER symptoms in patients with severe COPD. Patients with severe COPD based on FEV 1 50% of predicted (gray bars) had a higher prevalence of significant GER symptoms (heartburn and/or regurgitation once or more per week) compared with less severe COPD based on FEV 1 > 50% (striped bars) and control subjects (open bars). *p 50% vs control subjects. Percent (%) ** * *

Figure 3. Proportion of COPD patients with significant GER symptoms who reported increased respiratory symptoms associated with reflux events. A total of 19 patients with COPD reported significant GER symptoms on the modified version of the Mayo Clinic GER questionnaire (see "Materials and Methods" section). Five of these patients (26%) reported increased respiratory symptoms, such as wheezing, shortness of breath, and/or cough associated with reflux events. 26% (n = 5) respiratory symptoms with reflux events 74% (n = 14) no respiratory symptoms with reflux events ALL COPD patients with significant GER symptoms (n = 19)

Figure 4. Higher use of antireflux medications by COPD patients. The proportion of patients with COPD (gray bars) compared to control subjects (open bars) receiving over-the-counter antacids once or more per week, daily H 2 -RAs, or PPI therapy is indicated. Some patients were receiving multiple therapeutic regimens (eg, antacids and other prescription strength antireflux medications). *p < 0.05 COPD patients vs control subjects. Percent (%) * * * n=13 n=43 n=1 n=6 n=2 n=22 n=14 n=50

Figure 1. Effects of antireflux surgery on cough severity and health-related dysfunction due to cough at three time points. Data are plotted as individual points and as mean ± SE. Top: cough severity reflected by VAS scores. Bottom: health-related dysfunction reflected by ACOS scores. Compared to scores a median of 23.7 days before surgery, VAS and ACOS scores significantly decreased over 1 year following antireflux surgery. For each subject, all VAS and ACOS scores were lower at both postsurgery time points compared to before surgery. The values before surgery were obtained while patients had been receiving intensive antireflux medical therapy that included total/near-total esophageal acid suppression for a median of 14 months.

Figure 1. Albuterol inhalation produces a dose-dependent reduction in LES basal tone. Reductions in LES basal tone were statistically significant (p = 0.02) at cumulative dose 3 (ie, 7.5 mg total) and cumulative dose 4 (ie, 10.0 mg total). Error bars represent SE.

Figure 2. Resting LES pressure in control subjects (n = 8, open bars) and subjects with asthma (n = 8, closed bars) during baseline and after inhalation of methacholine and salbutamol. Results are expressed as mean + SEM (no significant difference). LES pressure (mm Hg)

Figure 4. Number of acid reflux episodes in control subjects (n = 8, open bars) and subjects with asthma (n = 8, closed bars) during baseline and after inhalation of methacholine and salbutamol. Results are expressed as mean + SEM (*p = 0.04 versus baseline and not significant versus salbutamol, **p = 0.02 versus baseline). * **

Figure 2. Correlation of URS scores with the number of distal esophageal reflux episodes during 24-h pH probe studies. Regression line: y = 0.01x , r 2 = 0.22, r = 0.47, p = Vertical line: upper normal limit of reflux episodes/24 h (50 episodes).

Figure 3. Comparison of symptom prevalence in volunteers, subjects with normal esophageal pH studies, and subjects with GERD. % p = p = 0.02

Variables COPD Patients(n=100)Control Subjects(n=51)p Value Age, yr 69.8   BMI, kg/m   Smoking, pack-yr 87   43 < Coffee, cups/d 2.3   Alcohol, drinks/d0.21   DEMOGRAPHICS OF CONTROL SUBJECTS AND PATIENTS WITH COPD

Control Subjects(n=51) Subjects with Asthma p Value FEV 1, L 4.1   FEV 1, % of predicted   FVC,L 4.7   FEV 1 /FVC 86.0   2.4 < BASELINE PULMONARY FUNCTION IN SUBJECTS WITH ASTHMA AND CONTROL SUBJECTS (mean  sem)