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Persistent wheezing and gastroesophageal reflux in infants
Author(s) -
Eid Nemr S.,
Shepherd Ross W.,
Thomson Michael A.
Publication year - 1994
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950180110
Subject(s) - medicine , reflux , pediatrics , intensive care medicine , disease
We have evaluated the presence of gastroesophageal reflux (GER) and the effect of its treatment in 12 infants (mean age, 7 months; range, 4–11 months) with persistent wheezing not responding to bronchodilators and anti‐inflammatory asthma medications. All patients had GER on cineradiography and significant acid reflux on 24 hour pH monitoring (percentage of time pH < 14 ranged from 6.1 to 47%). All infants were initially treated with prokinetic agents and with receptor histamine antagonists in addition to aggressive pulmonary therapy. Six patients treated medically had substantially decreased use of asthma medications, completely discontinuing them within 2–4 months. Two patients, though significantly improved, require intermittent asthma therapy. Four patients responding poorly to GER and asthma treatment for 2 months to 2 years had fundoplications. These had an excellent outcome over 1–4.5 years follow‐up; only one patient required further asthma medications. Pulmonary function testing was done in six patients before and after 6–8 weeks of therapy indicating significant improvement in peripheral airflow: terminal flow/peak tidal expiratory flow (TEF 25 /PTEF), and percentage of total expiratory time to reach peak tidal expiratory flow (T p /T e or T me /T e ). Our experience suggests that evaluation for GER should be considered in infants with persistent wheezing. Aggressive medical and possibly surgical therapy for GER may resolve persistent wheezing. Pediatr Pulmonol. 1994; 18:39–44. © 1994 Wiley‐Liss. Inc.