Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease.

BACKGROUND: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. AIM: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. METHODS: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. RESULTS: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment. CONCLUSION: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.

[The preadmission nursing home assessment (PNHA) in Reykjavik 1992.].

No-one can be admitted to a nursing home in Iceland without a prior assessment of need, that is standardized in content and method. In 1992 there were 546 individuals in Reykjavik assessed in a need for nursing home placement, 304 (55.7%) in an unskilled (UNH) and 242 (44.3%) in a skilled nursing home (SNH). The mean age was 81.6 (+/-0.4) and 81.8 (+/- 0.5) years, respectively, with the same female: male ratio of 2:1. On January 1st 1993, 19.4 per 1000 inhabitants in Reykjavik 65 years of age or older were waiting for admission to an UNH, where notas 14.1 per 1000 waited for a SNH admission. Those who were waiting for an UNH had mostly social difficulties along with affective symtoms, but those who were waiting for a SNH, had in addition to social difficulties, impaired physical and mental capacity with greater functional deficits. The PNHA was simplified with each of the twelve variables divided into a lower and higher level of difficulty. A logistic regressions analysis found seven independent variables predicting SNH placement: physical health, use of medications, dementia, mobility, abil notity to eat, ability to dress and groom, control of urine and stools. Of those assessed in a need for SNH 78.5% had dementia of some degree. Physical function and mobility appear to be relatively preserved until late in the dementia. These analyses confirm the validity of a PNHA, which is based on disabilities in four domains: social, physical, mental and functional health.