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
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