(461) Airway and Acid: Gastroesophageal Reflux Disease Impact in Patients Admitted for Asthma Exacerbation

Introduction: Gastroesophageal reflux disease (GERD) can serve as a trigger for asthma symptoms leading to bronchoconstriction, increasing the likelihood of asthma exacerbation. Outpatient studies like Irwin et al observed GERD had a negative effect on asthma control. Studies regarding the influence of GERD on in-patient asthma course are lacking. We evaluated the in-hospital outcomes of patients admitted with acute asthma, comparing those with and without GERD.

Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2020. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with asthma exacerbation as a principal diagnosis with GERD as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF), need for mechanical ventilation (MV), and ventilator-associated pneumonia (VAP). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders.

Results: About 472,425 patients were admitted for asthma exacerbation from 2016 to 2020 of which 118,555 (25%) had underlying GERD. The GERD group was older, with a mean age of 55.8 years [CI 55.5 - 56.0] vs 48.6 [CI 48.5 - 48.8]. Asthma exacerbation with comorbid GERD was not associated with higher inpatient mortality (AOR 0.41, 95% CI 0.28 - 0.61, P=0.000), ARDS (AOR 0.80, 95% CI 0.61 - 1.06, P=0.118), ARF (AOR 0.90, 95% CI 0.85 - 0.94, P=0.000), MV (AOR 1.15, 95% CI 0.67 - 1.97, P=0.606) or VAP (AOR 1.29, 95% CI 0.54 - 3.05, P=0.565) compared to those without GERD.

Conclusions: Patients admitted for asthma exacerbation with co-existing GERD did not have an associated higher inpatient mortality or higher incidence of ARDS or requirement for MV. This provides insight into this debated topic in a different setting. More studies will be required to assess our findings further.