Understanding Reflux-Induced Asthma

What Is Reflux-Induced Asthma?

Many surveys suggest that 15 million Americans suffer from asthma, and that 34% to 89 percent of asthmatics have gastroesophageal reflux disease (GERD), and that up to 40 percent of asthmatics have peptic esophagitis. Two major mechanisms of reflux-induced asthma have been proposed:

 

  • Aspiration of gastric contents into the lung with consequent spasm of the airways.
  • Reflux-induced activation of a neurological reflex from the esophagus to the lung causing narrowing of the bronchi or airways in the lung
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    It is important to understand that even a minuscule amount of acid can cause severe restriction of the airway. It is felt that most patients probably suffer from aspiration, however the reflux mechanism is probably important in some patients.

    Identifying the patient with reflux-induced asthma whom the asthma would benefit from antireflux therapy is a clinical challenge. At present, one should suspect a reflux cause of asthma in an individual who has non-allergic asthma and symptomatic reflux, particularly if there is a strong temporal association that can be drawn between the development the disease entities. What is especially important is asthma or coughing that occurs at night or after meals. This is often associated with reflux.

     

    Treatment

    The simplest and best way to treat patients with reflux-induced asthma is to follow lifestyle modifications of antireflux therapy. These would include:

     

    Avoid foods and beverages that contribute to heartburn such as:

     

  • chocolate
  • coffee
  • peppermint,
  • greasy or spicy foods,
  • tomato products
  • alcohol
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    Help yourself by:

     

  • Stop smoking
  • Reduce weight if too heavy
  • Do not eat two to three hours before sleep
  • Head-of-bed elevation at night if symptoms occur at night
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    The second method of treatment is medications using proton pump inhibitors such as Prilosec, Prevacid, Nexium, Aciphex, and Protonix, often twice a day. It is very important that these medications be taken 30 minutes before breakfast and supper. Usually one needs very strong therapy at least twice a day. However, some patients may benefit with just once-a-day therapy. What all patients should realize is that it will take at least three months, and possibly six months, on this strong medical therapy before you will see significant improvement in ones asthma.

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