Asthma Complexities - GERD

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Gastroesophageal reflux disease (GERD)

GERD is a common condition caused by the regurgitation (reflux) or backwash of stomach acid into the esophagus from the stomach. At times, the acid even may regurgitate into the back of the throat and reach the lungs. GERD usually -- but not always -- is associated with a burning discomfort under the breastbone, called heartburn, which occurs mostly after meals or when lying down. In some patients, the symptom of acid reflux is not heartburn. Instead, they experience coughing, wheezing, hoarseness, or sore throat.

The presence of acid in the esophagus or the passage of acid into the lungs (aspiration) may cause the bronchial tubes to constrict (bronchospasm), causing wheezing and coughing that may not respond to medications for asthma. Bronchospasm related to acid reflux tends to occur more frequently at night as a result of lying down. GERD is common among patients with asthma. Some doctors believe that asthma itself or asthma treatments in some way make asthma patients more susceptible to acid reflux. For example, theophylline, an oral medication occasionally used to treat asthma, may promote acid reflux by relaxing the specialized muscles in the esophagus that normally tighten to prevent regurgitation of acid.

In patients with nocturnal or difficult-to-control asthma, treating acid reflux may help relieve coughing and wheezing. Treatment of GERD involves elevating the head of the bed, losing weight, avoiding spicy food, caffeine, alcohol, chocolate and cigarettes. Proton-pump inhibitors such as omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), lansoprazole (Prevacid), and esomeprazole (Nexium) are potent inhibitors of production of acid in the stomach and are effective treatments for asthma aggravated or caused by acid reflux. Rarely, surgery is performed to prevent acid reflux for severe cases of GERD that do not respond to medications.

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