Asthma with Gastroesophageal Reflux

Asthma is a narrowing of the breathing passages of the lungs that comes and goes. It is most often caused by an allergy or by irritants that get into breathing passages. It is estimated that over half of patients with asthma also have gastroesophageal reflux disease (GERD). Physicians look for GERD as a cause of asthma when:

  • Asthma begins in adulthood
  • Asthma does not improve with asthma treatments
  • Asthma symptoms are worse after meals, with exercise or when lying down
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Symptoms

Persons with the condition may experience:

  • Cough
  • Shortness of breath
  • Wheezing, which is breathing that can be heard along with a tight feeling in the chest
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Diagnosis

The diagnosis of asthma is made with special breathing tests called pulmonary function tests. These tests tell the doctor if the breathing passages are narrowed. The diagnosis of asthma is made if medications that relax the breathing passages improve the pulmonary function tests and breathing.

If the doctor suspects that asthma is caused or made worse by laryngopharyngeal reflux other tests may be done.

  • Laryngoscopy is used to see changes of the throat and voice box caused by laryngopharyngeal reflux.
  • 24-hour ambulatory intra-esophageal pH testing. This is used to see if too much stomach acid is moving into the esophagus. Two pH sensors are used. One is at the bottom of the esophagus and one at the top. This lets the doctor tell if acid moves to the top of the esophagus.
  • Impedance-pH testing. This is used to determine if too much stomach contents of any kind, acid or not, move up into the esophagus.
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Treatments

Asthma is treated by drugs that relax the muscle of the breathing passages. Drugs also reduce swelling and/or stop the breathing passages from responding to irritation.

Asthma caused or made worse by laryngopharyngeal reflux is assessed in the same way as the latter condition.

Lifestyle changes

Ways that patients may help relieve the condition include:

  • Elevating the head of the bed four to six inches
  • Avoiding alcohol, chocolate and caffeine
  • Avoiding overeating
  • Eating or drinking nothing two to three hours before bed
  • Avoiding greasy, fatty foods
  • Losing weight
  • Maintaining a healthy weight
  • Abstaining from smoking

Medical options

The doctor may suggest one or more of the following treatments:

  • Antacids to offset having too much stomach acid
  • Anti-secretory drugs that lower acid production by the stomach. These include two types of drugs: histamine 2 receptor blockers and proton pump inhibitors.
  • Surgery to tighten the junction between the stomach and esophagus. The most common surgery is done by wrapping the top part of the stomach around the junction between the stomach and esophagus. It is then sewn in place.