The Asthma-Reflux Connection
My daughter started wheezing in early infancy and she was sick almost continuously with a respiratory illness, ear infection or pneumonia. She was on all kinds of medications from antibiotics, breathing treatments and steroids. The signs of asthma were frequent and obvious: wheezing and coughing with every illness or exposure to smoke and other irritants. It took a long time to figure out that gastroesophageal reflux disease was driving the constant coughing and wheezing. Rather than spit up or vomiting, she had silent reflux-stomach acid would come up her throat and cause a hoarse voice, throat clearing and a bad taste in her mouth. Worst of all, asthma and reflux were causing frequent night waking so we were both sleep deprived. It turns out that reflux and asthma often occur together.
There are different theories on the cause and effect of asthma and reflux. There is some evidence that coughing can trigger reflux by relaxing the lower esophageal sphincter (where the stomach meets the esophagus) allowing food and acid to escape into the esophagus and triggering wheezing and coughing. In rare cases, acid may trickle into the lungs causing aspiration. Also, reflux and especially silent reflux can irritate the throat and lungs causing coughing and wheezing. The bottom line is asthma and reflux are both common and may occur together. To further complicate matters, some of the medications used to treat asthma may relax the lower esophageal sphincter and increase reflux symptoms. Even the antibiotics used to treat respiratory illnesses may cause stomach upset and digestive discomfort. Long term antibiotic use may kill the good bacteria and flora in the stomach leading to further digestive distress.
What you need to know:
- Reflux and asthma are both common and may occur together.
- Reflux treatments may indirectly improve breathing and asthma symptoms.
- Asthma and reflux symptoms may overlap. Coughing (especially a night cough), poor sleep and throat clearing may be due to asthma, reflux or both.
- You may need to work with your primary care doctor to find the best treatments for both asthma and reflux.
- It may be necessary to get a referral to a gastroenterologist and an asthma specialist (pulmonologist) if your child has complications or does not respond to treatment.
- The signs of reflux may be subtle and include a sore throat, throat clearing and a bad taste in the mouth. Other symptoms may be unexplained weight loss or poor growth, picky eating and poor response to asthma treatment.
- A child with reflux may need to be evaluated for asthma if she has reflux and an unexplained cough and frequent respiratory illnesses, croup or pneumonia.
My daughter was on a high dose of asthma medication until we started treating the reflux. Over time, her asthma symptoms were reduced and she was able to breathe better. Thankfully, the respiratory illnesses decreased to a more manageable level and her sleep improved too.