Gastroesophageal Reflux and Asthma
By Donald R. Elton, MD, FCCP
Lexington Pulmonary and Critical Care
One thing that is frequently overlooked in difficult to control asthma
is evaluation and/or treatment for gastroesophageal reflux. In some patients,
small amounts of stomach acid will make their way up the esophagus and into the
airways causing wheezing, coughing, hoarseness in some patients, chest pain or
back pain, and other symptoms. Some say that as much as half of all adult onset
asthma is really GERD (GastroEsophageal Reflux Disease). In my practice I
usually just give a few weeks of Prilosec or Prevacid (strong though expensive
antiacids) rather than going straight to testing. Many patients have nearly
complete relief of asthma symptoms after this trial thus clinching the
diagnosis. Testing is more involved and expensive than a trial of therapy in my
experience but may be required in difficult cases. I've had a few patients go
from 4 or 5 asthma drugs to Prilosec alone for this particular problem. There
may be no other symptoms aside from the wheezing to indicate that reflux is
going on so absense of acid taste etc is not enough to say you don't have GERD.
GERD is typically worse at night (when supine) while asthma is usually just
worse at night whether supine or not though post nasal drip and reflux can
worsen asthma when supine too.
GERD is worse if you eat within a few hours of going to bed.
GERD is worse if you sleep flat as opposed to having the head of the bed
elevated.
GERD is worse if you're obese or pregnant.
GERD is worse if you eat chocolate or mints (these can relax the esophagus
more).
Rarely someone will get surgery for reflux but the meds are pretty effective
in most cases even if they do run $3 a pill (once daily therapy is the norm).