Assuntos
Embolia Paradoxal/etiologia , Polipose Intestinal/complicações , Embolia Intracraniana/etiologia , Telangiectasia Hemorrágica Hereditária/complicações , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Isquemia Encefálica/etiologia , Cromossomos Humanos Par 18/genética , Ecocardiografia Transesofagiana , Embolização Terapêutica , Epistaxe/etiologia , Saúde da Família , Humanos , Polipose Intestinal/genética , Íntrons , Escore Lod , Masculino , Artéria Pulmonar/anormalidades , Proteína Smad4/genética , Telangiectasia Hemorrágica Hereditária/genética , Tálamo/irrigação sanguínea , Ultrassonografia Doppler TranscranianaRESUMO
OBJECTIVE: To study the relationships between airway responsiveness to methacholine and capsaicin, proximal or distal reflux and the effects of short-term acid inhibition. MATERIAL AND METHODS: Twenty-nine asthmatics, not taking steroids regularly, underwent respiratory symptom measurements, 24-h dual-probe pH monitoring, and challenges with methacholine and capsaicin. Challenges and symptom measurements were repeated after 12 days' omeprazole treatment (20 mg b.i.d.). The results (median and range) were expressed as PD20 methacholine (mg) and PD5 capsaicin (dose causing five coughs, nmol). RESULTS: Seventeen patients presented pathological reflux in the distal esophagus, and 17 in the proximal esophagus. At baseline no correlation was found between PD20 or PD5 and reflux. Treatment with omeprazole did not change bronchial responsiveness to methacholine (basal: 0.16 mg, 0.02-1.27; omeprazole: 0.15 mg, 0.02-1.60); omeprazole decreased the tussive response to capsaicin (basal: 0.08 nmol, 0.08-2.46; omeprazole: 0.61 nmol, 0.08-9.84, p<0.001) only in patients with pathological reflux. The decrease was positively correlated with proximal acid exposure (r2=0.70, p<0.001). Omeprazole reduced asthma symptoms in patients with proximal reflux, cough in those with proximal or distal reflux. CONCLUSIONS: In asthmatics, inhibition of gastric acid secretion does not influence bronchial hyperresponsiveness but decreases tussive sensitivity and this effect is related to proximal reflux.