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From The Doctor’s Desk

Acid Reflux and Asthma

How is gastroesophageal reflux disease (GERD) related to asthma?

It is estimated that more than 75 percent of patients with asthma also experience acid reflux otherwise known as gastroesophageal reflux disease (GERD). People with asthma are twice as likely to have GERD as those people who do not have asthma. Of those people with asthma, those who have a severe, chronic form that is resistant to treatment are most likely to also have GERD.

GERD is the backward flow of stomach acids into the esophagus. When this acid enters the lower part of the esophagus, it can produce a burning sensation, commonly referred to as heartburn. If left untreated, GERD can eventually lead to lung damage, esophageal ulcers, and in some instances Barrett's esophagus, a condition that can eventually lead to esophageal cancer.

Does GERD cause asthma?

Although studies have shown a relationship between asthma and GERD, the exact relationship is uncertain. GERD may worsen asthma symptoms, but asthma and some asthma medications may in turn worsen GERD symptoms. However, treating GERD often helps to also relieve asthma symptoms, further suggesting a relationship between the two conditions.

Doctors most often look at GERD as the cause of asthma when:

  • Asthma begins in adulthood
  • Asthma symptoms get worse after a meal, after exercise, at night or after lying down
  • Asthma doesn't respond to the standard asthma treatments.

How can GERD affect my asthma?

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. This will cause a shortness of breath.

What should I do if I have asthma and GERD?

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.

Fortunately, many of the symptoms of GERD can be treated and/or prevented by taking steps to control or adjust personal behavior. 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 smoking, which 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. Under rare circumstances, GERD may only be treatable through surgery.

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  • American Academy of Allergy Asthma,& Immunology. Gastroesophageal Reflux Disease (GERD) Accessed 7/2/2013.
  • American College of Asthma, Allergy, & Immunology. GERD and Asthma Management Accessed 7/2/2013.
  • Riscili BP, Parsons JP, Mastronarde JG. Treating silent reflux disease does not improve poorly controlled asthma. Clev Clin J Med. 2010;77(3):155–160.