Q: “Whenever I have reflux after meals, my asthma tends to flare up. How does gastroesophageal reflux disease (GERD) affect asthma and what is the treatment?”
Kevin McGrath, MD: GERD is the result of acid from the stomach refluxing into the esophagus (food pipe) and trachea (windpipe). Typical symptoms are pain in the chest area (under the sternum), a bad taste in the mouth or bad breath, sore throat, cough and laryngitis. Studies show that between 30 to 80 percent of asthma patients also have GERD.
GERD affects patients of all ages from infants to seniors. There are two ways that are thought to explain how GERD can trigger asthma.
The first is that reflux of acid from the stomach into the esophagus triggers the vagal nerve (a cranial nerve that extends from the brain to the stomach and affects multiple body organs), making the lungs more sensitive to asthma triggers. This increases the asthmatic response to other asthma triggers such as allergens and irritants.
The second is that small acidic particles from the stomach get into the airways and cause tightening of the airways.
GERD triggers include large meals, fatty and fried foods, garlic, onions, acidic foods such as citrus and tomato, caffeine, smoking, alcohol, spicy foods, mint flavoring and eating 2-3 hours before bedtime.
Overuse of quick-relief inhalers such as albuterol can also trigger GERD. The albuterol can loosen the muscle that keeps stomach acid from getting up into the esophagus. GERD is due to failure of this muscle to stay tight enough to keep all the acid in the stomach.
If you have asthma and symptoms of GERD, discuss this with your board-certified allergist. GERD can often trigger asthma and mimic the same symptoms as nasal allergies (runny nose, cough and sore throat). Some patients get silent reflux where they don’t have the typical chest pain or burning symptoms of GERD.
GERD is usually diagnosed by an upper endoscopy test performed by a gastroenterologist. Prevention and treatment strategies include:
- elevate the head of the bed (the torso needs to elevated, so using several pillows won’t work)
- stop smoking
- decrease alcohol and caffeine consumption
- avoid eating 2-3 hours before bedtime
- avoid heavy meals in the evening
- lose weight
- take medications as prescribed
Proton pump inhibitors like Nexium and antacids are the usual medication treatments; talk with your doctor about correct use of proton pump inhibitors as high doses and prolonged use can increase the risk of infections, bone fractures and dementia.
GERD can also slightly increase the risk of developing pneumonia, chronic bronchitis, COPD and idiopathic pulmonary fibrosis.
If GERD is suspected, discuss your symptoms with your allergist.
Kevin P. McGrath, MD, FACAAI, FAAAAI, is a board-certified allergist and immunologist in Wethersfield, Connecticut. He is a spokesperson and fellow with the American College of Allergy, Asthma & Immunology (ACAAI).
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