GERD May Be Causing Your Uncontrolled Asthma Symptoms

If your asthma is uncontrolled, especially if you are having nighttime symptoms, gastroesophageal reflux disease (GERD) may be to blame. As many as 75% of patients with difficult to treat asthma also experience frequent heartburn. GERD is one of the most common conditions that contribute to uncontrolled asthma, and you may need to get evaluated. Symptoms of GERD include:

• Regurgitation or the sensation of the acid and your food backing up; the wet burp is another way patients sometimes describe this
• Frequent heartburn or pyrosis, the painful burning in your stomach and mid-chest caused by acid from your stomach going up into and irritating your esophagus
• Sour or bitter taste in your mouth. Depending on the severity, the reflux may cause a sour or bitter taste, or you may get a sudden sensation of a salty fluid in your mouth called water brash. Water brash results from the stomach acid stimulating salivary glands to produce saliva

Acid is normally prevented from going up into the esophagus from the stomach by a muscular ring that is present at the junction of the stomach and esophagus. When this ring relaxes acid can move from the stomach upward. Once acid is in the esophagus, it is possible for you to aspirate it into the lungs. Another hypothesis is that acid entering the esophagus stimulates nerves there and triggers airways to narrow.

Your asthma provider may choose to order some tests depending on your symptoms, or he may just start a therapeutic trial to see if your uncontrolled asthma symptoms improve.

Your provider may offer you a number of possible treatments for GERD:

• Diet Modification: Avoiding or altering your intake of foods that are known to worsen GERD may be all that you need. These foods include alcohol, fried foods, chocolate, and caffeinated drinks.
• Lifestyle Changes: There are a number of things you can do to improve your asthma symptoms. They can include avoiding eating or drinking 3 hours before lying down and elevating the head of your bed. Eating smaller meals more often is another way to decrease the risk of reflux. Small amounts of elevation can allow gravity to work for you and decrease symptoms. Raising the head of your bed by several inches uses gravity as a method of keeping acid in the stomach.
• Medications: Your doctor may prescribe an over-the-counter medication, such as Pepcid AC or Prilosec OTC (patients often use a number of other OTC GERD treatments such as Maalox, Mylanta, Gelusil, Gaviscon, Rolaids, and Tums). Your doctor may also recommend a prescription medication. These include H-2-receptor blockers such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) or ranitidine (Zantac). Proton pump inhibitors are another class of prescription meds that include Dexlansoprazole (Dexilant), Esomeprazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec, Zegerid), Pantoprazole (Protonix), and Rabeprazole (Aciphex). These medicines do not provide immediate relief like antacids but suppress acid production in the stomach for around 12-24 hours. If these medications are going to help your GERD, it is unlikely that any one is more effective than the other. Likewise, if one in a class does not work it is unlikely that another drug in that same class would be helpful. If your symptoms persist, your provider may refer you for further testing.
• Surgery: While not usually necessary, some patients with bad reflux may choose surgery if medical treatment fails or they would rather not have to take medications for the rest of their life.

Both medical and surgical treatments have been shown to decrease nighttime symptoms, decrease the frequency of asthma exacerbations, and improve the quality of life in asthma patients. Be sure to keep your doctor informed of how you're feeling—better or worse. However, if treatment does not improve your asthma symptoms, you and your doctor should consider other causes.