Community Asthma Care Centre improves access to diagnostic procedure

The constant and debilitating cough that plagued Bev Rowter for more than a year is gone.

The Conquerall Mills woman credits South Shore Health’s Community Asthma Care Centre and a diagnostic procedure introduced to this District more than two years ago for her ability to return to work and a normal life after months of uncertainty about her health and future.

“I can’t believe how great I feel,” says Bev, who only a few months ago couldn’t carry on a conversation or walk up stairs without coughing violently and uncontrollably. “At one point, I thought I would have to cope with this the rest of my life.”

That was before staff at the Community Asthma Care Centre in Lunenburg identified her as a candidate for a 24-hour pH probe, an investigative tool used to measure acidity in the esophagus and diagnose gastroesphogeal reflux disease (GERD). Reflux is the term used to describe a backflow of acid from the stomach into the esophagus. Symptoms include chest pain, difficult or painful swallowing and heartburn, and an uncomfortable, burning sensation behind the breastbone. GERD can also cause asthma, coughing or wheezing and inflammation of the vocal cords with hoarseness. However, many patients experience no symptoms.

“A pH probe is much more sensitive and specific than any other diagnostic tool used to diagnose reflux, including x-ray and endoscopy,” says the Centre’s Medical Director Dr. Anthony Atkinson, whose work is contributing to the growing body of evidence linking asthma and reflux. “The association between respiratory problems and reflux is not new. It has been recognized since the turn of the century. However, there’s been a growing interest in this area over the past few years and it is now an area of active research.”

While most pH probes are conducted through Gastroenterology labs, Dr. Atkinson saw an opportunity to increase accessibility by offering the test through the Community Asthma Care Centre. The Fishermen’s Memorial Hospital Auxiliary purchased the required equipment. The Community Asthma Care Centre in Lunenburg is the only asthma centre in the Maritime Provinces offering the diagnostic test, which Dr. Atkinson says is the most accurate, but least used method for diagnosing reflux.

“It’s certainly the gold standard for diagnosing reflux. Depending on the severity, a patient diagnosed with reflux can then be treated with medications, appropriate lifestyle changes or surgery, which has proven to be very successful,” he says.

That’s certainly the case for Bev, whose quality of life deteriorated rapidly after developing asthma, allergies and a chronic cough in 2001. Although she was treated for asthma, she showed little improvement and her cough continued to get progressively worse. By June 2002 she could no longer work or do most of the activities she enjoyed. In September she had a pH probe.

To conduct the test a dual-sensor catheter is advanced into the nose and down the esophagus. The catheter is connected to a small computer worn on a belt. The sensors measure and record the acidity in the esophagus. The patient records activities such as sleeping and eating and keeps track of any symptoms they experience such as chest pain, coughing, wheezing, heartburn, burping, or sneezing. The catheter is removed 24 hours later and the information is downloaded onto a computer, which calculates the Symptom Associated Probability Score.

“This is the probability that a particular symptom is associated with reflux,” says Asthma Centre RN Marie McIntyre. “If the scores are high, there’s an extremely good chance that treatment will result in improvement. If they’re low, then the test has helped to rule out reflux as the cause.”

Bev’s tests showed significant reflux. In November, she underwent a Laparoscopic Nissen Fundoplication to tighten the valve at the end of the esophagus. After recovering from the surgery, she improved in “leaps and bounds.” The chronic cough she had experienced for over a year was gone. The stomach pain she’s experienced since 1978, which she now attributes to GERD, is also gone. She returned to work in January.

Since 2001, there have been more than 50 pH probes performed at the Asthma Centre.

Dr. Atkinson and Ms MacIntyre will present official results from the Centre at an upcoming meeting of the American Thoracic Society.