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      Laryngopharyngeal reflux COPD to uncover reflux and columnar lined esophagus

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          Abstract

          Dear editor With interest we read the article by Jung et al1 published in the recent issue of the International Journal of Chronic Obstructive Pulmonary Disease. An important finding of the study was the positive correlation between symptoms of gastroesophageal reflux disease (GERD), endoscopic signs for laryngopharyngeal reflux (LPR), and COPD.1 COPD represents an increasing health burden.2,3 Owing to the symptoms, COPD impairs the productivity and life quality of those affected.2,3 Frequently, COPD requires chronic administration of cortisone therapy, which itself produces side effects impairing well being.4,5 The finding that COPD associates with LPR and GERD opens the trail for additional diagnostic and therapeutic considerations. If GERD is suspected, one may want to define the amount, characteristics, and components of GERD. Thus, endoscopy and histopathology of esophageal biopsies help to assess the morphologic manifestation of GERD, ie, hiatal hernia, esophagitis, and columnar lined esophagus in the distal or proximal portion of the esophagus.6 Presence of Barrett’s esophagus defines increased cancer risk and may be managed by surveillance or, in cases of increased cancer risk (dysplasia), by elimination of Barrett’s esophagus tissue by endoscopic radiofrequency ablation (±endoscopic mucosal resection).6 Furthermore, esophageal manometry and reflux monitoring characterize reflux, that causes symptoms, ie, aggravates COPD and LPR.5,6 In summary, the orchestration of diagnostic findings offers the path for a tailored therapy, ie, medical, nutrition or, in cases of advanced GERD, resolution of reflux by laparoscopic anti reflux surgery.5,6 Going in line with the considerations of Jung et al1 we think that LPR-positive COPD patients should be offered the above algorithm to attenuate the progression of the disease and the need for cortisone therapy.2,4 We kindly ask the authors to address the above suggestions.

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          Most cited references 7

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          Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease

          Background Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that affects an estimated 10% of the world’s population over the age of 40 years. Worldwide, COPD ranks in the top ten for causes of disability and death. Given the significant impact of this disease, it is important to note that acute exacerbations of COPD (AECOPD) are by far the most costly and devastating aspect of disease management. Systemic steroids have long been a standard for the treatment of AECOPD; however, the optimal strategy for dosing and administration of these medications continues to be debated. Objective To review the use of corticosteroids in the treatment of acute exacerbations of COPD. Materials and methods Literature was identified through PubMed Medline (1950–February 2014) and Embase (1950–February 2014) utilizing the search terms corticosteroids, COPD, chronic bronchitis, emphysema, and exacerbation. All reference citations from identified publications were reviewed for possible inclusion. All identified randomized, placebo-controlled trials, meta-analyses, and systematic reviews evaluating the efficacy of systemic corticosteroids in the treatment of AECOPD were reviewed and summarized. Results The administration of corticosteroids in the treatment of AECOPD was assessed. In comparison to placebo, systemic corticosteroids improve airflow, decrease the rate of treatment failure and risk of relapse, and may improve symptoms and decrease the length of hospital stay. Therefore, corticosteroids are recommended by all major guidelines in the treatment of AECOPD. Existing literature suggests that low-dose oral corticosteroids are as efficacious as high-dose, intravenous corticosteroid regimens, while minimizing adverse effects. Recent data suggest that shorter durations of corticosteroid therapy are as efficacious as the traditional treatment durations currently recommended by guidelines. Conclusion Systemic corticosteroids are efficacious in the treatment of AECOPD and considered a standard of care for patients experiencing an AECOPD. Therefore, systemic corticosteroids should be administered to all patients experiencing AECOPD severe enough to seek emergent medical care. The lowest effective dose and shortest duration of therapy should be considered.
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            Confront COPD International Patient Survey: methods, COPD prevalence, and disease burden in 2012–2013

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              Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis

              Objective To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder–Oaxaca linear decomposition technique. Methods This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006–2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder–Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Results Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors between the two groups. Need factors explained up to 41% of the differences in average health care expenditures between the two groups. Conclusion Among elderly Medicare beneficiaries with COPD, the presence of GERD was associated with higher expenditures. Need factors primarily contributed to the differences in average health care expenditures, suggesting that the comanagement of chronic conditions may reduce excess health care expenditures associated with GERD.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2015
                30 September 2015
                : 10
                : 2095-2096
                Affiliations
                Upper-GI-Service, Gastroesophageal Tumor Unit, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
                Author notes
                Correspondence: Sebastian F Schoppmann, Upper-GI-Service, Gastroesophageal Tumor Unit, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, Tel +43 1 4 0400 5621, Fax +43 1 4 0400 5641, Email sebastian.schoppmann@ 123456meduniwien.ac.at
                Article
                copd-10-2095
                10.2147/COPD.S93711
                4598195
                © 2015 Kristo et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Letter

                Respiratory medicine

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