The Asthma and Acid Reflux (GERD) Connection
There is a surprising connection between asthma and acid reflux. Anywhere from 75-80% of asthmatics suffer from acid reflux. Acid reflux is also known by the name of gastroesophageal reflux disease (GERD). Acid reflux is a condition where the acidic stomach contents travel in the wrong direction and enter the esophagus (swallowing tube). This causes a variety of symptoms of which the main one is heartburn. People with acid reflux commonly feel a burning sensation in the chest and/or throat. They often complain of a bitter or sour taste in their mouth. Other symptoms can include wheezing, coughing, belching, abdominal bloating, sore throat, nausea, and/or the feeling that something is stuck in one’s throat. It is the wheezing and coughing symptoms that cam mimic asthma or in fact be triggered in an asthmatic who has acid reflux or GERD.
Acid reflux occurs because the lower esophageal sphincter, a muscle at the lower part of the esophagus near the entrance to the stomach, becomes too relaxed. This allows the stomach acid to go backwards into the esophagus which can cause damage to the esophagus and cause a burning sensation, commonly referred to as heartburn. In addition to causing heartburn, it also can aggravate a person’s asthma in a couple of different manners. The first way this occurs is a result of small amounts of this acid irritating the airways (like a chemical burn) which can trigger asthma symptoms. The second way may involve triggering a reflex in the airways to become narrower in order to prevent more acid from entering the airways. It is this narrowing of the airways which causes an asthmatic to wheeze, cough, and/or feel short of breath. In addition, some asthma medications can decrease the lower esophageal sphincter pressure thereby relaxing this muscle which subsequently will increase the severity of acid reflux. Asthma medications in the bronchodilator family such as Albuterol (i.e., Proventil, Ventolin, ProAir, AccuNeb), Levalbuterol (Xopenex), Terbutaline, (i.e., Brethine, Brethaire), Salmeterol (Serevent), Formoterol, (Foradil), Vilanterol, Ipatroprium (Atrovent), and Tiotropium (Spiriva) fall into this category. There are also asthma medications that are combinations of two medications, one of which is a bronchodilator, which can therefore increase acid reflux disease. The names of some of these medications include Advair, Symbicort, Dulera, Breo Ellipta, Combivent, and DuoNeb. Theophylline (i.e., Theo-Dur, Uniphyl, Theo-24, Slo-Bid), an older but still useful oral bronchodilator asthma medication, has also been linked with increasing acid reflux in individuals by causing the relaxation of the lower esophageal sphincter as well. Interestingly, the chemical structure of Theophylline is similar to caffeine which is another trigger of acid reflux.
The cause of acid reflux disease is a failure of the lower esophageal sphincter to function properly. There are several risk factors that can contribute to acid reflux disease and some of them include:
- Hiatal hernia – the protrusion of part of the stomach through the diaphragm (a muscle separating the abdomen from the chest) into the chest
- Use of certain medications (i.e., bronchodilators, calcium channel blockers, aspirin, prednisone)
- Alcohol use
- Certain foods – caffeine, fatty foods, garlic, onions, spicy foods, and acidic foods (i.e., tomatoes, soda, citrus fruits)
- Eating before bed
- Eating large meals
- Certain connective tissue disorders – Scleroderma or systemic sclerosis
The diagnosis can be made with a combination of a good history from the individual along with observing relief when prescribed medications to control reflux such as antacids and/or acid-blocking medications. If there is no improvement in symptoms of acid reflux, there are several procedures that can be performed to help diagnose acid reflux disease. Some of these procedures include upper endoscopy with or without biopsy, barium swallow, esophageal manometry (checks the function of the lower esophageal sphincter and esophagus), and pH monitoring (checks the acidity in the stomach).
The treatment of acid reflux disease is aimed at minimizing the risk factors mentioned above in addition to prescribing antacids and acid-blocking medications. By treating the underlying acid reflux disease in the asthmatics that have this condition, the symptoms of asthma (i.e., wheezing, coughing, shortness of breath, and chest tightness) may also be diminished)
The board certified allergists at Black & Kletz Allergy recognize the association between asthma and acid reflux (GERD) and we treat our asthmatics accordingly after a thorough history and physical examination. Black & Kletz Allergy has 3 offices and has been serving the Washington, DC, Northern, Virginia, and Maryland metropolitan area for more than 50 years. We have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have parking at each location and the Washington, DC and McLean, VA (Tysons Corner, VA) offices are Metro accessible. If you have asthma, think you have asthma, or have symptoms of wheezing, coughing, shortness of breath, and/or chest tightness, please call us to schedule an appointment. Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.