Heartburn and Asthma
It is estimated that more than 75% of patients with asthma also experience
frequent heartburn, a condition called gastroesophageal reflux disease (GERD).
People with asthma are twice as likely to have GERD as those people who do not
have asthma. Of the people with asthma, those who have a severe, chronic form
of asthma that is resistant to treatment are most likely to also have GERD.
GERD is the chronic backward flow of stomach acids into the esophagus.
Usually, stomach acid is kept in the stomach by a valve at the bottom of the
esophagus called the lower esophageal sphincter. Sometimes, this valve becomes
faulty. When this acid enters the lower part of the esophagus, it can produce a
burning sensation, commonly referred to as heartburn. If left untreated, GERD
can eventually lead to lung damage, ulcers in the esophagus (the swallowing
tube), and in some instances "Barrett's esophagus," a condition that
may lead to esophageal cancer.
Does GERD cause asthma?
Although studies have shown a relationship between asthma and GERD, the
exact relationship is uncertain. GERD may worsen asthma symptoms, however,
asthma and some asthma medications may worsen GERD symptoms. On the other hand,
treating GERD often helps to also relieve asthma symptoms, further suggesting a
relationship between the two conditions.
Doctors most often look at GERD as the cause of asthma when:
- Asthma begins in adulthood, called adult-onset asthma
- Asthma symptoms get worse after a meal, after exercise, at night or after lying down
- Asthma doesn't respond to the standard asthma treatments.
How can GERD affect my asthma?
As previously mentioned, the exact link between the two conditions is
uncertain. However, there are a few possibilities as to why GERD and asthma may
coincide. One possibility is that the acid flow causes injury to the lining of
the throat, airways and lungs, making inhalation difficult and often causing a
persistent cough.
Another potential link to asthma for patients with GERD is that when acid
enters the esophagus, a nerve reflex is triggered, causing the airways to
narrow in order to prevent the acid from entering. This will cause a shortness
of breath.
Aside from these possible relationships between asthma and GERD, one study
showed there was an increase in the rate of GERD in patients with asthma who
were treated with asthma medications known as bronchodilators. However, further
studies must be done before the relationship between GERD and these drugs can
be fully understood.
What should I do if I have asthma and GERD?
If you have both asthma and GERD, it is important that you consistently take
any asthma medications your doctor has prescribed to you, as well as control
your exposure to asthma triggers as much as possible.
Fortunately, many of the symptoms of GERD can be treated and/or prevented by
taking steps to control or adjust personal behavior. Some of these steps
include:
- Raise the head of your bed by six inches to allow gravity to help keep the
stomach's contents in the stomach. (Do not use piles of pillows because this
puts your body into a bent position that actually aggravates the condition by
increasing pressure on the abdomen.)
- Eat meals at least three to four hours before lying down, and avoid bedtime
snacks.
- Eat smaller meals with moderate portions of food.
- Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure
caused by extra pounds.
- Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, colas
and alcohol—all of which relax the lower esophageal sphincter—and tomatoes
and citrus fruits or juices, which contribute additional acid that can irritate
the esophagus.
- Give up smoking, which also relaxes the lower esophageal sphincter.
- Wear loose belts and clothing.
Aside from these steps, over-the-counter antacids such as Tums, Rolaids,
Maalox, Zantac, Tagamet, Pepcid, and Axid can often relieve GERD symptoms.
However, if after two weeks these medications do not help with your symptoms,
your doctor may prescribe medications that block or limit the amount of stomach
acid your body produces. Under rare circumstances, GERD may only be treatable
through surgery.
Reviewed by the doctors at The Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine.
Reviewed by Michael W. Smith, MD, on September 7, 2007
Edited by James E. Gerace, MD, on December 1, 2006
Portions of this page copyright ©
The Cleveland Clinic 2000-2004
Last Editorial Review: 12/19/2007
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