Gastro-oesophageal reflux and childhood asthma: the acid test.

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Abstract
The presence of gastro-esophageal reflux was investigated in 18 children with moderate to severe asthma by overnight esophageal pH monitoring. Appreciable reflux was found during sleep in 8; its relevance to nocturnal asthma was not clear. On another occasion the same children were challenged in a double blind fashion with a drink of dilute hydrochloric acid (0.001 N) and the response of the airways was monitored by peak flow measurements and by histamine challenge tests. There was a significant increase in mean histamine sensitivity (P = 0.001) 90 min after the acid drink without any associated change in baseline peak flow rate. Eight children had a significant response to the acid drink and a further 3 reacted to a more concentrated solution (0.01 N). In those asthmatic children in whom reflux is associated with a positive response to an acid drink (5 out of 18 in this study) it seems likely that reflux exacerbates nocturnal symptoms.