Conference Coverage

GI disorders more prevalent in children with poorly controlled asthma

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Comment by Dr. Susan Millard, MD, FCCP

Dr. Susan Millard

Dr. Susan Millard

It is so important to understand what comorbidities our patients may have, and this article highlights gastrointestinal concerns for our asthma patients. It is an excellent prospective study in a wide range of ages, and I hope that this research will be expanded to benefit our patients and help us to manage their health more effectively.



– Pediatric patients who have asthma that is poorly controlled may be more likely to have functional gastrointestinal (GI) disorders, which feature chronic GI distress that has several causes, according to a study of patients treated at one hospital.

“This study suggests a high prevalence of functional GI disorders among patients with persistent asthma. Moreover, patients with functional GI disorders had poor asthma control and increased anxiety. Clinicians should consider functional GI disorders in patients with poor asthma control and assess for anxiety as indicated,” Ruben J. Colman, MD, a pediatric resident at SBH Health System, Bronx, N.Y., said at the Pediatric Academic Societies meeting.

A girl using an asthma inhaler. Louis-Paul St-Onge/iStockphoto
The prospective, cross-sectional study recruited patients aged 4-20 years at the emergency department, pediatric inpatient unit, and ambulatory clinics at St. Barnabas Hospital, a 422-bed, not-for-profit, acute care community hospital. Those with persistent asthma, which was evident by an ongoing history of daily inhaled corticosteroid medication, were enrolled.

Functional GI disorders including functional abdominal pain, irritable bowel syndrome, and functional dyspepsia were evaluated. The study was prompted by the knowledge that these conditions are a common cause of chronic GI symptoms in children, and from the findings of a retrospective study of 30,000 patients in Europe that reported a higher prevalence of asthma in those with functional GI disorders, compared with those without chronic GI distress (Aliment Pharmacol Ther. 2014 Aug;40[40]:382-91). Data are scarce in North America concerning asthma control and functional GI disorders in both pediatric and adult populations.

The validated Questionnaire on Pediatric Gastrointestinal Symptoms–Rome III version was used to assess functional GI disorders. Asthma control was assessed using the childhood Asthma Control Test (ACT) questionnaire, with scores exceeding 30, less than 19, and less than 14 indicating well-controlled, not well-controlled, and poorly controlled asthma, respectively. Anxiety was assessed using the Beck Anxiety Inventory, with increasing scores indicating increasing anxiety.

The 110 enrolled patients had a mean age of 10 years. Age was similar between the 18 patients with functional GI disorders – representing a prevalence rate of 16% – and the 92 without such disorders at 12 and 10 years, respectively. Those with functional GI disorders were predominantly female, compared with the patients without a functional GI disorder (72% vs 45%; P less than .03). The GI distress in the 18 patients comprised 10 cases of abdominal pain disorders and 13 cases of upper GI tract disorders, with 3 patients having an overlap of 2 to 3 functional GI disorders.

Patients with functional GI disorders had a lower mean ACT score, compared with those without (12 vs. 15; P = .03). Functional GI disorders also were associated with higher anxiety scores (34 vs. 14; P less than .01).

Asthma control significantly predicted the presence of functional GI disorders in univariate analysis (odds ratio, 0.9; 95% confidence interval, 0.80-0.99; P = .03). However, this significance was lost in a multivariate analysis that adjusted for asthma control, anxiety, and sex. The multivariate analysis revealed continued significant associations between functional GI disorders and anxiety (OR, 1.1; 95% CI, 1.01-1.10; P less than .01) and female sex (OR, 3.3; 95% CI, 1.00-10.56; P less than .05).

Dr. Colman speculated that the apparent association of asthma with chronic GI distress could reflect asthma-related inflammation that exacerbates the GI disorders. Future research should examine if improving the control of asthma and lessening anxiety can decrease symptoms of functional GI disorders.

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