People with asthma often experience acid reflux or heartburn and are also twice as likely to suffer from gastroesophageal reflux disease (GERD), the main acid reflux producer. However, the connection is not as simple as it sounds.
Is there a connection?
The connection between asthma and GERD (the backward flow of acidic stomach content into the esophagus) was first noted in 1892 by Sir William Osler who observed the negative effects on asthmatics when eating certain foods and “overloading” the stomach. Several studies have been undertaken since then to try and establish the connection between the two (see article GER or GERD).
What has been established is that asthma and acid reflux often occur together, that GERD may worsen asthma symptoms and vice versa and that treating GERD often helps relieve asthma symptoms. The conclusion reached was that although not all asthmatics experience acid reflux or GERD, an estimated 75% do and both conditions should be monitored and treated simultaneously to reach the best outcomes.
Identifying the culprit
The involvement of GERD is suspected when asthma symptoms appear in adulthood (adult-onset asthma); are worse at night, after exercise, after meals or when lying down; when frequent acid reflux (heartburn) is present and asthma doesn’t get better after standard asthma treatment.
Treatment consists of treating both conditions simultaneously. Standard asthma medication and therapies should be continued and maintained with one exception, namely the use of certain asthma medicines such as Theophylline that increase acid reflux and other GERD symptoms, and some bronchodilator inhaled medicines that may have the same effect. It is most important though to speak to your doctor and follow his/her recommendations about these medications.
Treating and preventing GERD symptoms need a two-pronged response:
The first is taking recommended and approved medication. Three categories of medication are currently recommended, namely:
- Proton pump inhibitors (PPIs) to suppress gastric acid secretion
- H2 Antagonists to inhibit acid secretion by blocking histamine receptors
- Antacids to neutralise gastric acid.
The second is making some lifestyle changes such as:
- Avoiding the food and drinks (fatty food, tomatoes, citrus fruits, juices, chocolate, coffee, tea, colas and especially alcohol) that trigger GERD
- Not eating or drinking at least two to four hours before going to bed
- Lifting the head of the bed
- Not smoking
- Eating a healthy diet to maintain the proper body weight. Obesity exacerbates both asthma and GERD
- Taking pressure off the abdominal area by dressing in loose clothes and belts.
When all else fails
Surgery or surgical anti-reflux therapy are last resort options that can only be recommended by your doctor. Several studies have suggested that surgical intervention did improve GERD and asthma symptom control.
Heartburn and asthma. 2012. Retrieved from: http://www.webmd.com/asthma/guide/heartburn-asthma
James, TCU. Is there a connection between asthma and acid reflux? Retrieved from: http://www.mayoclinic.com/health/asthma-and-acid-reflux
Kristi, MI. 2009. The relationship between GERD and asthma. Retrieved from: http://www.medscape.com/viewarticle