Acid Reflux and Asthma
In this entry, I would like to discuss the connection between acid indigestion/acid reflux (gastroesophageal reflux disease, or GERD) and asthma. This is an area of active interest in the asthma community for both patients and clinicians, particularly in patients with more difficult to control asthma.
How can acid reflux cause wheeze?
We have all drank something too fast and had it “go down the wrong pipe,” leading to cough and a brief choking sensation. Fortunately, our bodies have very effective mechanisms of keeping things we are trying to swallow from going into our lungs. This is due to the fact that the area around the vocal cords, the “doorway” to the windpipe and lungs, is extremely sensitive to stimulation by anything other than air, such as liquid or food. When this happens, we have a brisk cough reflex, which clears anything that is “getting too close” to the lungs.
This reflex, which connects the back of the throat to the lungs and diaphragm, has related connections between the larynx and breathing tubes. In some individuals, particularly asthmatics, stimulation of the laryngeal area not only leads to cough but can lead to reflex narrowing of the airways deeper in the lungs. In asthmatics, this causes wheeze.
Individuals with acid reflux or GERD, for a variety of reasons (type of food intake, obesity, timing of meals), have problems when small amounts of stomach contents, including stomach acid, go back up the esophagus (which connects the mouth to the stomach) even into the back of the throat near the larynx. Since the lining of the esophagus is not “used to” acid exposure, most people with acid reflux have a burning sensation often after meals in the middle of their chest – the acid refluxing up from the stomach. If this acid goes high enough to ‘tickle’ the larynx/voicebox area, it can trigger not only cough but spasm of the muscles lining the airways of the lungs, causing wheeze.
Some patients (whether they have asthma or not) may not feel a sensation of acid reflux, but may have unexplained cough. This is so-called “silent reflux,” because the symptoms of the reflux are not typical. Either typical or silent reflux can be a significant trigger in some asthma patients, and should be considered in asthmatics who are particularly afflicted with wheezing at night.
Who should get treatment for reflux?
Any asthmatic that has typical symptoms of acid reflux that are associated with wheeze should discuss treatment options with their asthma care provider. These include important lifestyle modifications and medications, either over the counter or by prescription.
Figuring out whether “silent reflux” is the cause of wheeze, cough, or other asthma symptoms can be trickier. In some cases, if aggressive conventional quick relief and controller medications are not working fully, a trial at reflux-specific medications may be reasonable. You should discuss these options with your doctor.
Frederic Little is an Assistant Professor in the Department of Medicine at Boston University. He attends on the Allergy Consultation Service as well as the Medical Intensive Care Unit and Pulmonary Consultation Service at Boston Medical Center. He wrote for HealthCentral as a health professional for Asthma and Allergy.