3. BACKGROUND & AIM THE IMPACT OF GERD ON EXACERBATIONS OF COPD HAS NEVER BEEN EVALUATED. TO DETERMINE THE PREVALENSI OF GER SYMPTOMS IN COPD PATIENTS & THE EFFECT OF GER ON THE RATE OF EXACERBATIONS OF COPD PER YEAR A I M BACKGROUND

4. MICROASPIRATION OF GASTRIC CONTENTS VAGAL NERVE INDUCED BRONCHOSPASM FROM GASTRIC ACID IRRITATION OF THE ESOPHAGUS GERD PULMONARY DISEASE/ SYMPTOMS PULMONARY FIBROSIS CHRONIC BRONCHITIS PNEUMONIA ASTHMA INTRODUCTION

5. ACUT EXACERBATIONS OF COPD HYPERCAPNIA WORSENING DYSPNEA SPUTUM PRODUCTION ↑↑ PURULENT SPUTUM HYPOXEMIA

6. RISK FACTORS FOR ACUTE EXACERBATIONS OF COPD AIRWAY IRRITATION ENVIRONMENTAL FACTORS UPPER RESPIRATORY TRACT INFECTION MICRO ASPIRATION OF GASTRIC CONTENT ACTIVE SMOKING

7. MATERIALS & METHODS PATIENTS JANUARY 2003-JANUARY 2004 COPD N=91 PATIENTS The Pulmonary Speciality Clinics At The University Florida Jacksonville

8. PATIENT INCLUSION CRITERIA EXCLUTION CRITERIA FEV1/FVC Ratio ≤ 70% Age ≥ 40 Years History of smoking ≥ 20 pack-year Respiratory disorders other Esophageal disease (cancer, achalasia, Stricture, active peptic ulcer disease, Zollinger-ellison syndrome, mastocytosis, Scleroderma) Current abuse of alcohol

9. PROTOCOL WEEKLY SYMPTOMATIC REFLUX (GERD(+)) ACUT COPD EXACERBATION STANDARDIZED QUESTIONNAIRE

10. STATISTICAL ANALYSIS FISHER EXACT TEST INDEPENDENT T TEST CATEGORIAL DATA INTERVAL DATA

11. R E S U L T

16. DISCUSSION

17. The aim of this study: - to demonstrate the prevalence of symptomatic GERD in our sampled population - to demonstrate the prevalence of symptomatic GERD in our sampled population - to determine if there was an epidemiologic association between GER symptoms & exacerbations of COPD. - to determine if there was an epidemiologic association between GER symptoms & exacerbations of COPD. The most significant finding is that patients with the diagnosis of COPD & weekly GER symptoms have more acute exacerbations of COPD than without GER symptoms. Other significant observations were the increased number of hospitalizations, ED, & unscheduled clinic visits as well as antibiotics usage was greater in the weekly GERD COPD population.

18. Our data have shown that there is a trend toward more exacerbations of COPD in the GERD(+) groups whether they were receiving anti-reflux therapy or not, so we can’t conclude that the use of anti-reflux therapy was/wasn’t protective against exacerbation. Why they are still having symptomatic reflux despite therapy? Further research will be needed to answer this question. Although a statistically significant association between GER symptoms & exacerbations of COPD was observed, our major limitation was that we can’t establish a cause-and-effect association from the cross-sectional data gathered.

19. C O N C L U S I O N S The patients who have COPD & also reflux symptoms at least once a week are more likely to have an increased number of COPD exacerbations when compared to COPD patients who are either asymptomatic/have GER symptoms < once a week. COPD patients with weekly GER symptoms & COPD are twice as likely to be hospitalized, ed visit, or unscheduled clinic visit when compared with COPD patients with < frequent GER symptoms.