Insight Into the Relationship Between Gastroesophageal Reflux Disease and Asthma
Initial studies in patients with asthma from gastroesophageal reflux. What is the link between asthma and gastroesophageal reflux disease? Researchers have discovered that GERD can trigger asthma symptoms. In addition. When asthma and acid reflux do occur together medications may not work as well to control signs and symptoms of either condition, such as coughing.
The Surprising Connection Between GERD and Asthma | Everyday Health
As previously mentioned, the exact link between the two conditions is uncertain. However, there are a few possibilities as to why GERD and asthma may coincide. One possibility is that the acid flow causes injury to the lining of the throat, airways and lungs, making inhalation difficult and often causing a persistent cough. Another possibility for patients with GERD is that when acid enters the esophagus, a nerve reflex is triggered, causing the airways to narrow in order to prevent the acid from entering.
Asthma and acid reflux: Are they linked? - Mayo Clinic
This will cause a shortness of breath. If you have both asthma and GERD, it is important that you consistently take any asthma medications your doctor has prescribed to you, as well as controlling your exposure to asthma triggers as much as possible.
Some of these steps include: Raise the head of your bed by six inches to allow gravity to help keep the stomach's contents in the stomach. Do not use piles of pillows because this puts your body into a bent position that actually aggravates the condition by increasing pressure on the abdomen. Eat meals at least three to four hours before lying down, and avoid bedtime snacks. Eat smaller meals with moderate portions of food.
Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra pounds. Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, colas, and alcohol - all of which relax the lower esophageal sphincter - and tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus.
Give up smokingwhich also relaxes the lower esophageal sphincter. Wear loose belts and clothing. Aside from these steps, over-the-counter antacids can often relieve GERD symptoms. However, if after one to two weeks these medications do not help with your symptoms, your doctor may need to prescribe medications that block or limit the amount of stomach acid your body produces. I wonder if there are other effects of GERD, such as worsening of vocal cord dysfunction, that may mimic asthma and have led us in the past to erroneously conclude that GERD was worsening asthma.
Several theories have been advanced, with the most common one being that pressure swings in the thorax of asthmatics allow more acid to reflux into the esophagus. These and other animal studies suggest that chronic microaspiration from GERD may trigger bronchoconstriction and also possibly increase inflammation in the airways.
However, this hypothesis has not been adequately tested in humans. JGM I am not certain that there is a good answer to this question.
It may be that effective treatment of GERD results in an improvement in overall well-being and is, thus, reflected in improved quality of life related to asthma. JGM Most studies looking at GERD treatment and asthma have evaluated either H2 blockers or proton pump inhibitors, which, as is known, do not cure reflux. Thus far, all of the studies evaluating whether Nissen fundoplication or other surgical procedures that eliminate reflux improves asthma outcomes have been case reports or very small cohort studies; no randomized trials have yet been conducted on this issue.
As the findings have been variable, definitively answering this question would require a large randomized trial of Nissen fundoplication versus sham Nissen fundoplication in well-defined asthma patients with objective evidence of GERD.
However, this study would be expensive and challenging to conduct, so I am not certain that we will get a good answer to this question. Likewise, when determining whether these patients should receive surgical therapy, doctors should follow the standard guidelines for treatment of refractory GERD.
JGM There are no data available on the impact of these recent data on clinical practice. It will be interesting to see how the NIH asthma guidelines review this issue, as I expect that the NIH may change its previous recommendation for a trial of empiric GERD treatment in poorly controlled asthmatics. There are growing concerns of side effects of proton pump inhibitor therapy, including a potential increase in upper respiratory infections or pneumonias as well as fractures in children.
In addition, these medications are very expensive. However, my major concern is that a proton pump inhibitor trial in asthma patients with asymptomatic GERD will have no impact on their asthma and just delays other therapies focused on their asthma.
JGM As mentioned above, the relationship between alkali reflux and asthma should be further investigated. At this time, the major need is education regarding the new evidence that asymptomatic GERD does not impact asthma, which will hopefully steer clinicians toward other, more effective therapies for their patients with poorly controlled asthma. Lansoprazole for children with poorly controlled asthma: Treating silent reflux disease does not improve poorly controlled asthma. Cleve Clin J Med.
Effects of asymptomatic proximal and distal gastroesophageal reflux on asthma severity.
Is There a Relationship Between GERD and Asthma?
Gastroesophageal reflux disease and asthma. Curr Opin Pulm Med. Efficacy of esomeprazole for treatment of poorly controlled asthma. N Engl J Med. Lansoprazole Asthma Study Group.