Severe Heartburn And Asthma Often Go Hand In Hand: What Asthmatics Should Know About Acid Reflux

Heartburn is a symptom which we all experience once in a while. Spicy food, lying down after overeating, and some medications can cause it. However, some people are more prone to heartburn and suffer it very frequently. The most common cause of recurring heartburn is Gastroesophageal Reflux Disease (GERD), also called Acid Reflux Disease.

GERD is a disorder in which there is a regurgitation of content from the stomach to the esophagus. Gastric content is very acid, and it causes the damage to the esophageal mucosa. Patients experience it as a burning sensation and pain in the upper abdomen and/or lower chest. These symptoms can vary from mild to disabling and they sometimes require hospitalization. Long-term untreated GERD can lead to more severe disorders, such as esophagitis and Barrett's esophagus (a condition which can evolve into cancer).

What does acid reflux have to do with asthma?

Asthma is a chronic inflammatory disease of the airways, and at first sight, there is no obvious relationship with acid reflux. However, there are many studies claiming that these two illnesses are related in some patients. Due to differences in study designs, the percentage of patients with asthma who also have acid reflux and heartburn differs between these studies, but it stands somewhere between 30 and 65 percent.

In people with GERD, content from the stomach can reach the pharynx, so some of the content can be inhaled. We are not talking about chunks of food, but about gasses and evaporations which can irritate the mucosa of the airways, thus causing hyperactivity of their walls and asthma. Another theory is that GERD causes asthma by disturbing the activity of the vagus nerve, which is responsible for regulating the function of multiple internal organs. Genetics may also play an important role here, because the lungs and the esophagus have a similar embryonic origin.

On the other hand, asthma can cause GERD through multiple mechanisms. Exhalation is the hardest part of the breathing cycle in patients with asthma, so their lungs almost always contain more air than they should. The result of that is increased pressure in the chest cavity which can contribute to the development of acid reflux and GERD.

Symptoms of asthma induced by acid reflux

Symptoms of asthma are usually the same, regardless of the cause. There might be worsening of the symptoms of asthma during intense attacks of heartburn. This conclusion can be biased too, because heartburn invokes stress, and the stress can be a trigger for asthma attack.

How to diagnose asthma caused by GERD?

It is hard to determine the origin of asthma, and even if the patient presents with GERD, we cannot simply make a conclusion about the causative relationship. Esophageal pH monitoring is a technique which continuously measures the acidity in the lumen of the esophagus, and it is a very popular way to determine whether the patient has GERD, but still, no causal relationships with asthma can be inferred. One of the best methods so far can be an attempt to treat GERD and monitor changes in asthma symptoms. If they subside, it may mean that asthma had developed due to chronic acid reflux.

How does the treatment of GERD affect asthma?

GERD is treated with either histamine-2 blockers (ex. ranitidine) or proton pump inhibitors (omeprazole). During the treatment, scientists have noticed the improvement in asthma symptoms, especially in those patients who experience airway obstruction during the nighttime. However, this was not good enough evidence, because the subsequent studies showed different results. In any case, GERD should be treated, either with medications or surgically, even though it does not guarantee the relief of asthma symptoms.

How does the treatment of asthma affect GERD?

Many medications used in asthma treatment have a negative impact on GERD. These include beta-agonists (albuterol), corticosteroids, and aminophylline.

Conclusion

People with asthma and GERD should take the prescribed treatment, but also make sure to introduce some lifestyle changes. Lying right after eating is not recommended because it increases the chances of acid reflux. Overweight and obese individuals often have more pronounced symptoms, so a diet to reduce body weight, especially abdominal obesity, is advised. Foods that are too spicy and too acidic should be avoided, and regarding taking any additional medications, patients should first consult with their doctor.