Content of review 1, reviewed on July 13, 2021

This is a good and useful meta-analysis about the association between GERD and asthma exacerbations. The study is well conducted and analysed in detail. Although we are almost sure that GERD accompanies asthma both in children and adults, this study proves this association for asthma attacks in a well-conducted meta-analysis. However, the general and group specific OR s are not high enough to point to a strong relationship.
Page 10 Line 209: Why do you classify the association as "moderate", but not "low" ?

On the other hand, an important issue is that the meta-analysis included both adult patients and children. Although you gave the results of pediatric studies seperately within results section, the study is a mixed one in general.Maybe, only pediatric results should be given for PAI.
Page 11 Line 225:Prospective studies are more reliable in examining the association between outcome measure and risk factors. In fact, prospective studies in this metanalysis did not show a significant OR and a reliable CI. This is a limitation for your findings.
One of the important debates about this subject is "egg -chicken" relation. Hence,the bidirectional relation between asthma exacerbation and GERD should be explained in detail in the discussion section.
The following papers should be added to discussion:
Yang F, Busby J, Heaney LG, Menzies-Gow A, Pfeffer PE, Jackson DJ, Mansur AH, Siddiqui S, Brightling CE, Niven R, Thomson NC, Chaudhuri R; UK Severe Asthma Registry. Factors Associated with Frequent Exacerbations in the UK Severe Asthma Registry. J Allergy Clin Immunol Pract. 2021 Jul;9(7):2691-2701.e1. doi: 10.1016/j.jaip.2020.12.062. Epub 2021 Jan 15. PMID: 33460858.

Hozawa S, Maeda S, Kikuchi A, Koinuma M. Exploratory research on asthma exacerbation risk factors using the Japanese claims database and machine learning: A retrospective cohort study. J Asthma. 2021 Apr 29:1-19. doi: 10.1080/02770903.2021.1923740. Epub ahead of print. PMID: 33926352.

Ansari SF, Memon M, Kumar R, Rizwan A. Risk Factors Associated With Frequent Acute Exacerbations of Asthma. Cureus. 2020 Oct 22;12(10):e11090. doi: 10.7759/cureus.11090. PMID: 33240688; PMCID: PMC7681754.

Kim SY, Kim HR, Min C, Oh DJ, Park B, Choi HG. Bidirectional association between GERD and asthma in children: two longitudinal follow-up studies using a national sample cohort. Pediatr Res. 2020 Aug;88(2):320-324. doi: 10.1038/s41390-020-0749-1. Epub 2020 Jan 10. PMID: 31923915.

Source

    © 2021 the Reviewer.

References

    Narmeen, M., May, T. J., Francisco-Javier, G., Bahi, T. 2022. Gastroesophageal reflux disease and asthma exacerbation: A systematic review and meta-analysis. Pediatric Allergy and Immunology.

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