GERD and Asthma: What's the Connection?
You wouldn’t think there’d be a link between the stomach and asthma, yet even as far back as the 1970s asthma experts noticed a connection between asthma and gastrointestinal reflux (GERD).
What is GERD?
GERD is a condition where acid from the stomach works its way back up the esophagus. If this condition is left untreated long term, it can eventually lead to esophageal ulcers, esophageal cancer and even airway changes that can cause asthma.
According to the American Academy of Allergy, Asthma and Immunology (AAAAI.org), a sphincter at the bottom of your esophagus remains closed while food is being digested to prevent backwash. “However, sometimes it relaxes on the job, allowing stomach acid to flow back, or reflux, into the esophagus.”
About 75 percent of asthmatics have GERD, the same percentage of asthmatics estimated to have allergies. This is a significant percentage, especially when you consider only 20 to 30 percent of people who do not have asthma have GERD.
What is the Connection?
It almost seems asthma and GERD have a synergistic relationship, where some asthma medicines may worsen GERD, and GERD may worsen asthma. GERD has been proven to be an asthma trigger, yet recent studies show it may even cause asthma in some patients.
Actually, back in 2008, researchers at Duke University looked into this relationship. While studying mice, they discovered that “inhaling tiny amounts of stomach fluid… produces changes in the immune system that can drive the development of asthma.”
If your asthma gets worse after meals, at night, or when lying down, GERD may be considered as the likely cause.
Age and GERD
There are some children with GERD. In fact, when I was a patient of National Jewish back in 1985 my room mate had to sleep with the top half of his bed on stilts to prevent stomach backwash.
Usually, however, GERD is associated with adult onset asthma. If a 40-year-old, for example, all-of-a-sudden develops asthma symptoms, GERD is often considered to be the culprit. In fact, GERD Associated Asthma is often a diagnosis, or a sub-type of asthma.
The most common symptom of GERD is heartburn, although it may also cause a sour taste in your mouth, chest pain, chronic cough, trouble breathing at night, sore throat, recurring pneumonia, chronic sinusitis, cavities, inflammed gums, bad breath, or no symptoms at all.
Too often symptoms aren’t noticed, and GERD goes uncontrolled. AAAAI notes that in some cases this may lead to uncontrolled asthma. So a diagnosis is essential.
Testing for GERD
Frequently a diagnosis is made by symptoms alone. However, there are some tests that can help if needed.
The initial test is usually a barium swallow, where you drink a chalky liquid and radiology equipment allows fluid in your esophagus to show up as gray or black on a screen. I actually did this test as a kid and failed. So my doctor had me do the more invasive pH probe.
The pH probe is where a tube is inserted into your nose down to your stomach, and, while you’re sleeping, a printout shows if acid enters your esophagus. I actually passed this test, and GERD was ruled out back then.
Another diagnostic test is an endoscopy, which is where a scope is inserted into your mouth and the doctor can look at your esophagus and stomach. He can also take pictures and samples. I had this test done three times as an adult, and it’s really not as bad as it sounds.
So, what about treatment? Any of the following may be recommended, depending on the severity (this is what we’ll call the anti-reflux protocol):
- Elevate the head of the bed 6-8 inches
- Lose weight
- Stop smoking
- Decrease alcohol intake
- Limit meal size and avoid heavy evening meals
- Do not lie down within two to three hours of eating
- Decrease caffeine intake
- Cut back on carbonated beverages (beer and pop)
- Avoid theophylline (if possible)
- Avoid chocolate
- Medicine, such as prevacid and prilosec, to reduce stomach acid
You might be saying, why chocolate? Well, as you can see by this MSN health and fitness post, chocolate can relax the sphincter that normally blocks food from backwashing up the esophagus. Theophylline does the same thing, and so do caffeine and alcohol.
Carbonated beverages may increase stomach acid and cause bloating, both of which increase your risk for reflux, as do overeating and obesity.
While there is no conclusive evidence reflux therapy benefits asthma, it does control and prevent GERD. Actually, AAAAI notes a study that showed reflux therapy improved asthma symptoms in 69 percent of subjects, and reduced the need for asthma medicines in 62 percent of subjects.
I was diagnosed with GERD as an adult mainly due to poor diet and theophylline dependence. Newer asthma medicines have allowed me to be weaned off theophylline, yet my doctor says I’ll be chronically dependent to Prilosec as a trade off.
Yet the best way I’ve found to control both GERD and asthma is a good diet and
Actually, whether you have asthma or not, most experts believe reflux is preventable, and is usually the result of choices we make. If you have asthma, your increased risk for getting GERD is just another incentive to eat a healthy diet.
John Bottrell is a registered Respiratory Therapist. He wrote for HealthCentral as a health professional for Asthma and Chronic Obstructive Pulmonary Disease (COPD).