Exploration of the Role of Gastroesophageal Reflux Disease in Chronic Obstructive Pulmonary Disease Patients: A Nationwide Population-Based Cohort Study

Purpose:

    To investigate whether GERD is associated with an increased risk of severe acute exacerbation of COPD (AECOPD) by analyzing a nationwide health care database. 

Methods:

    This study employed a population-based retrospective cohort design. We conducted propensity score method with 1:2 matching. In this study we analyzed 1,976 COPD subjects with GERD and 3,943 COPD subjects as a comparison group. We individually tracked each subject in this study for 12 months and identified those subjects who experienced episodes of severe AECOPD required hospitalization or emergency department visit. The cumulative incidence of AECOPD was estimated using the Kaplan-Meier method to analyze the difference between two groups. Hazard ratios (HR) were calculated using Cox proportional hazards regression analysis. 

Results:

    The incidence of severe AECOPD was 3.40 and 2.34 per 1,000 person-months in individuals with and without GERD, respectively (P=0.0137). Following adjustment for sex, age, ischemic heart disease, heart failure, atrial fibrillation, hypertension, osteoporosis, anxiety, diabetes mellitus, angina, stroke, anemia, dementia, occupational category, monthly insurance premium, Cox regression analysis revealed that GERD was associated with severe AECOPD (HR=1.45, 95% CI=1.07 ~ 1.95).  

Conclusion:

    This study demonstrated that GERD is an independent risk factor for severe AECOPD. Caution should be exercised in COPD patients when assessing GERD symptoms in clinical practice.