It is estimated that more than 75% of patients with asthma also experience frequent heartburn from a condition called gastroesophageal reflux disease (GERD). People with asthma are twice as likely to have GERD as people who do not have asthma, especially those with treatment-resistant asthma.
GERD is the backward flow of acidic stomach content into the esophagus (acid reflux). Usually, stomach acid is kept in the stomach by a muscular ring at the bottom of the esophagus called the lower esophageal sphincter. If this sphincter becomes relaxed, it can allow stomach contents to back up into the esophagus, producing a burning sensation that is commonly referred to as heartburn. GERD can irritate asthma and damage the esophagus. It is believed that asthma attacks can also cause the sphincter to relax, making it easier for acid reflux to occur.
Although studies have shown a relationship between asthma and GERD, the exact relationship is uncertain. GERD may worsen asthma symptoms, and asthma and some asthma medications may worsen GERD symptoms. Treating GERD often helps to 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 reflux irritates the airways and lungs, which affects breathing and may make people more sensitive to outside conditions such as air pollution, cigarette smoke, and cold air.
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.
Some asthma medications can increase heartburn and other symptoms of GERD. Theophylline has been most closely tied to worsening GERD symptoms. Bronchodilators (a common type of inhaled asthma medication) may reduce the lower esophageal sphincter pressure and trigger GERD symptoms. However, further studies must be done before the relationship between GERD and these drugs is 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 treatments can often help relieve GERD symptoms. However, if after two weeks these medications do not help with your symptoms, your doctor may recommend prescription-strength medications that block or limit the amount of stomach acid your body produces. Under severe circumstances, surgery may be needed.
SOURCES: Johns Hopkins Health Alert: "Asthma and Gastroesophageal Reflux Disease (GERD) -- What's the Connection?" American Academy of Allergy, Asthma & Immunology: "Asthma and GERD," "Gastroesophageal Reflux Disease (GERD)."