Acid Reflux and Asthma: Are They Connected?

Is There a Connection Between Acid Reflux and Asthma?

Table of Contents
View All
Table of Contents

Acid reflux and asthma may not seem like they'd have much in common, but these two conditions often occur together and can make each other worse in several ways.

This mutual exacerbation commonly contributes to uncontrolled asthma; as many as 75% of people with hard-to-treat asthma frequently have heartburn, which is caused by acid reflux.

This article delves into the connections between acid reflux and asthma, the symptoms to watch for, plus their causes, diagnostic procedures, and treatments.

Signs You Have Co-Occuring Asthma and Acid Reflux

Verywell / Katie Kerpel

The Connection Between Acid Reflux and Asthma

Asthma is a chronic condition that causes the airways to narrow, leading to breathing problems.

Acid reflux happens when stomach acid backs up into the esophagus, causing a burning sensation (heartburn). If you have it more than twice a week, it's called gastroesophageal reflux disease (GERD).

The esophagus is usually protected from stomach acid by a muscular ring called the lower esophageal sphincter (LES). It opens when you swallow, then closes tight to prevent anything in the stomach from flowing back upward.

Asthma relaxes the lower esophageal sphincter, letting stomach acids enter the esophagus. That causes acid reflux symptoms and raises your risk of GERD. Many asthma medications can make GERD worse, as well.

Acid reflux worsens asthma by irritating your airways and stimulating nerves, which triggers asthma symptoms or attacks.

Symptoms

While they're very different conditions, acid reflux and asthma have some symptoms in common.

Acid Reflux Symptoms

Symptoms of acid reflux include:

  • Heartburn (pyrosis): Painful burning in your stomach and mid-chest from stomach acid in the esophagus
  • Regurgitation: A "wet burp" sensation of food coming back up, often coupled with nausea
  • Unpleasant tastes: A sour, bitter, or salty taste in your mouth

Additional GERD symptoms may be:

  • Nausea
  • Chest pain
  • Difficulty or pain while swallowing
  • Persistent sore throat
  • Hoarseness or voice changes
  • Chronic cough

Some of these symptoms are similar to those of asthma.

Asthma Symptoms

Symptoms of an asthma attack can include:

When acid reflux is also present, some of these symptoms may be compounded (and vice versa).

When Asthma Is an Emergency

If you have severe asthma symptoms or regular asthma symptoms that don't respond to your asthma medication, get emergency medical attention.

Reflux/GERD Symptoms
  • Chronic cough

  • Chest pain

  • Hoarseness

  • Heartburn

  • Regurgitation

  • Sour or bitter taste

Asthma Symptoms
  • Chronic cough

  • Chest pain

  • Hoarseness

  • Wheezing

  • Shortness of breath

  • Rapid breathing

Causes and Risk Factors

Most of the causes and risk factors of acid reflux and asthma are different, but they do have some in common.

Acid Reflux Causes and Risk Factors

Many people get occasional acid reflux, but if it's a frequent and ongoing issue, it may be due to a weakness or malfunctioning of the LES.

Things that can affect the LES and contribute to acid reflux and GERD, or make symptoms worse, include:

  • Gastric distention (a full stomach)
  • Pregnancy
  • Alcohol
  • Caffeine
  • Intake of certain foods, especially fatty foods
  • Hiatal hernia

Asthma medications that may contribute to reflux and GERD are:

Other drugs that may worsen reflux/GERD include:

Even if you suspect a medication is causing reflux or GERD symptoms, don't stop taking it or change your dose without first talking to the healthcare practitioner who prescribed it.

Asthma Causes and Risk Factors

In asthma, a strong reaction of the immune system creates inflammation and narrowing of the airways. Although asthma can occur at any age, it typically develops in childhood.

Possible asthma risk factors include:

  • A family history of asthma or inherited genes that affect how the immune system develops
  • Exposure to frequent viral infections in early childhood
  • Poor air quality from pollutants
  • Multiple allergies, such as food allergies and/or allergies to animal dander or pollen
  • Airway hyperreactivity (an exaggerated airway responsiveness to various stimuli)
  • Exposure to chemical irritants or industrial dusts

What triggers asthma symptoms varies from person to person.

Common Risk Factors

Of great importance in this context are two risk factors that apply to both conditions:

  • Having excess weight or obesity
  • Smoking or exposure to secondhand smoke

The good news is that you have some control over these risk factors.

Reflux Causes
  • Excess weight/obesity

  • Smoking/secondhand smoke

  • LES dysfunction

  • Medications, including some asthma medications

  • Hiatal hernia

  • Overeating

  • Pregnancy

  • Alcohol

  • Caffeine

Asthma Causes
  • Excess weight/obesity

  • Smoking/secondhand smoke

  • Genetic predisposition

  • Childhood infections

  • Poor air quality

  • Immune response to substances in the lungs

  • Allergens

  • Industrial chemicals

  • Airway hyperexcitability

Diagnosis

Your healthcare provider may suspect you have both acid reflux and asthma if:

  • Asthma symptoms continue despite treatment or a poor response to treatment
  • Asthma worsens after eating large meals or reflux-causing foods (high-fat meal, alcohol, chocolate, or caffeine)
  • You take asthma medications that may increase reflux
  • Your asthma symptoms began as an adult
  • You have unexplained nighttime asthma symptoms

Symptoms Worse at Night?

Acid reflux can be severe enough that you breathe food particles into your lungs while you're lying down. That may lead to nighttime asthma symptoms.

Acid reflux and GERD are often diagnosed based on symptoms, along with a treatment trial that may include lifestyle interventions and taking medication that suppresses acid production for four to eight weeks.

If you have asthma and your healthcare provider suspects you may also have GERD, they may immediately start such a therapy trial to see if your symptoms improve.

If they don't, lab and imaging tests may be ordered to diagnose GERD and rule out other gastrointestinal conditions. These can include the following.

  • Esophageal pH monitoring: A catheter is guided through the nose to the esophagus, or a small capsule is placed on the lining of the esophagus to monitor acid levels for 24 to 48 hours.
  • Upper endoscopy: A tube with a camera is guided through the mouth, esophagus, stomach, and upper part of the small intestine to examine the digestive tract and take biopsies if needed.

Asthma is diagnosed based on family and personal medical history, a physical exam, and results from diagnostic tests. These test may be ordered if you have signs of asthma plus reflux symptoms:

  • Pulmonary function tests: Spirometry or peak expiratory flow (PEF), which gauge speed and volume of forceful exhalations
  • Bronchodilation and bronchoprovocation tests: Measure your lungs' response to asthma medication or intentional airflow disturbance
  • Fractional exhaled nitric oxide tests: Measure levels of nitric oxide when you exhale
  • Skin or blood tests: Can identify allergies
Diagnosing GERD
  • Acid reflux more than 2x/week

  • Treatment trial to see if symptoms improve

  • Diagnostic tests such as esophageal PH monitoring

Diagnosing Asthma
  • Chronic asthma symptoms

  • Exam and medical history

  • Pulmonary function tests

  • Skin or blood tests for allergens

Treatment

Treatments for GERD and treatments for asthma focus on symptom prevention and control.

Your healthcare provider will help you develop a personalized asthma action plan to help you recognize triggers, including those related to GERD, and what steps to take based on symptoms.

Lifestyle Changes

You can use a variety of lifestyle strategies to manage and prevent symptoms of acid reflux and asthma.

Acid Reflux

Your provider may offer you a number of possible dietary and lifestyle interventions for acid reflux, such as:

  • Avoiding or reducing your intake of drinks and foods that can worsen reflux, such as alcohol, fried foods, chocolate, and caffeinated drinks
  • Instead of the standard three meals a day, eating smaller meals more often
  • Avoiding eating or drinking three hours before lying down
  • Elevating the head of your bed by several inches to use gravity as a method of keeping acid in the stomach
  • Quitting smoking
  • Losing weight if you are overweight or obese (even a loss of just a few pounds is sometimes enough to improve symptoms)
  • Avoiding tight-fitting clothes that increase pressure in the abdomen and make reflux more likely

Asthma

Lifestyle interventions for asthma may include:

  • Identifying asthma triggers and reducing or avoiding exposure to them
  • Environmental interventions, such as mold remediation, to reduce exposure to allergens
  • Quitting smoking or reducing exposure to secondhand smoke
  • Getting regular physical activity
  • Developing a plan to manage or reduce stress
  • Maintaining good sleep habits, such as keeping consistent sleep/wake times

Quitting smoking is one of the single best things you can do for your asthma and overall health, and it may also decrease reflux symptoms.

Reflux Medications

Your healthcare provider may prescribe medication or recommend an over-the-counter medication for acid reflux.

Research is mixed on whether GERD medications improve asthma symptoms. However, some evidence suggests GERD treatments improve quality of life and help ease nighttime symptoms of asthma and GERD.

If your healthcare provider suspects that your asthma is related to GERD, they'll likely prescribe an acid-suppressing medication for a month or two to see if asthma symptoms improve.

It's important to only take one type of medication for acid reflux or GERD at a time. Common medications include the following.

The U.S. Food and Drug Administration (FDA) in 2000 took the popular reflux drug ranitidine ( known by the brand name Zantac) off the market. Zantac is once again available but with famotidine instead of ranitidine.

H2-receptor blockers and proton pump inhibitors don't provide immediate relief like antacids, but suppress acid production in the stomach for around 12 to 24 hours. These drugs, especially PPIs, are commonly used for GERD-related asthma.

If asthma symptoms improve after a one- or two-month trial period on PPI, you may be prescribed the medication for an additional two months.

If these medications help your GERD, it is unlikely that any one will be more effective than the other. Likewise, if one medication in a class does not work, it is unlikely that another in that same class would be helpful. If your symptoms persist, your provider may refer you for further testing.

Asthma Medications

Medications prescribed for asthma vary based on severity and symptom triggers. Your healthcare provider may weigh the pros and cons of certain asthma medications that may aggravate GERD.

Side effects can vary by person, and you may need to test different drugs to see which ones control your asthma without worsening acid reflux. The most commonly prescribed medications for asthma include:

Many people are on both types of medication. Additional medications may be prescribed for allergic asthma, or if asthma is poorly controlled despite treatment.

If you have GERD and asthma, your healthcare provider will likely avoid theophylline as an add-on treatment. It's been shown to stimulate gastric secretions and increase GERD symptoms by 170%.

Your healthcare provider may avoid or delay prescribing oral corticosteroids for severe asthma, since high-dose corticosteroids may increase GERD and, in turn, exacerbate asthma. If you are prescribed oral corticosteroids, you may need careful monitoring.

If asthma symptoms become severe, they can cause respiratory distress and even lead to death, so adequate management is critical.

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

Surgery

While not usually necessary, some patients with severe GERD may choose GERD surgery if medical treatment fails or they would rather not have to take medications for the rest of their life.

A common surgical procedure to treat chronic acid reflux is fundoplication, which involves sewing the top of your stomach around your lower esophagus and LES. This procedure adds pressure to the LES in an attempt to strengthen it and reduce reflux.

If your GERD and asthma are related to an issue with the LES or hiatal hernia, surgical fundoplication may be considered.

Reflux/GERD Treatment
  • Antacids, PPIs, H2-receptor blockers

  • Avoidance/reduction of problem foods

  • GERD surgery

Asthma Treatment
  • Asthma action plan

  • Fast-acting rescue medications

  • Long-term control medications

  • Trigger avoidance/management

A Word From Verywell

It's important to consult a healthcare provider if you have symptoms of asthma and acid reflux, especially if they are occurring multiple times a week.

Aside from the fact that one condition can influence the other, each poses other potential complications as well. Both are common conditions with many treatment options to help prevent or relieve symptoms.

If you're already diagnosed with asthma or acid reflux but your symptoms change or get worse, tell your healthcare provider. Your medications or asthma action plan may need to be adjusted.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Allergy, Asthma & Immunology. Gastroesophageal reflux disease (GERD).

  2. Ates F, Vaezi MF. Insight into the relationship between gastroesophageal reflux disease and asthmaGastroenterol Hepatol (N Y). 2014;10(11):729–736.

  3. Asl SF, Mansour-Ghanaei F, Samadi H, Joukar F. Evaluations of life style factors and the severity of Gastroesophageal reflux disease; a case-control studyInt J Mol Epidemiol Genet. 2015;6(1):27–32.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of GER & GERD.

  5. National Institutes of Health, National Heart, Lung, and Blood Institute. Asthma.

  6. Hu Z-W, Wu J-M, Liang W-T, Wang Z-G. Gastroesophageal reflux disease related asthma: From preliminary studies to clinical practiceWorld Journal of Respirology. 2015;5(1):58. doi:10.5320/wjr.v5.i1.58

  7. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in gastroesophageal reflux diseaseClin Gastroenterol Hepatol. 2016;14(2):175–82.e823. doi:10.1016/j.cgh.2015.04.176

Additional Reading

By Pat Bass, MD
Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.