What Appears to Be Asthma At Age 50 May Actually Be Acid Reflux
Oct. 19, 1999 (Phoenix) -- When is asthma not asthma? When it's gastroesophageal reflux disease (GERD), the chronic heartburn that has become the primary GI disease of the waning days of the 20th century. From legendary Baltimore Oriole Cal Ripken Jr. to the clerk in the local supermarket, the incidence of GERD is on the rise, and many times it doesn't cause the typical heartburn that is the hallmark of the disease.
GERD, according to experts meeting here at the 64th annual scientific meeting of the American College of Gastroenterology, results when stomach acid is refluxed or splashed back into the esophagus. Eventually the esophagus becomes damaged by the constant exposure to acid, and in some cases that damage can even lead to esophageal cancer.
In most people reflux causes heartburn, but in a growing number of patients it is causing symptoms that are not readily associated with GERD. In Ripken's case it caused laryngitis. Other people are walking into the doctor's office at age 50 with what appears to be the first signs of asthma, only to find out that they are actually experiencing asthma-like symptoms caused by GERD.
Philip O. Katz, MD, a presenter at the conference, says such symptoms are becoming so common that he recommends patients with an asthma-like condition be given a strong acid blocker known as a proton pump inhibitor, such as Prevacid (lansoprazole) or Prilosec (omeprazole). These drugs shut down acid production in the stomach and are very effective at reducing the symptoms and preventing the damage associated with GERD.
Katz, who is an associate professor of medicine at Graduate Hospital in Philadelphia, says that people who experience 'typical symptoms,' such as heartburn or bloating, are given one pill, and that those with unusual symptoms need twice as much of the drug. He prescribes a pill before breakfast and another before the evening meal.
Katz isn't alone in his warning about atypical GERD. Joel E. Richter, MD, the chief of gastroenterology at the Cleveland Clinic Foundation and a former president of the American College of Gastroenterology, tells WebMD, "I would suspect GERD in any patient with asthma that is [difficult to treat]. While this is more common in older patients, I would suspect it in patients of any age."
Although Katz says proton pump inhibitors work just as well with atypical GERD as with typical GERD, he says they usually take longer to achieve an effect: "It could take as long as 3 to 4 months, and it can be difficult to convince the patient to stay with the treatment." Richter agrees that it takes longer to get a clinical response than it does in patients who have the more common heartburn symptoms, though he says "patients will probably tell you that they begin to feel better after a month or so." Once improvement in symptoms is achieved, the patient should be monitored, says Katz.
Katz adds that atypical patients, as well as patients with symptomatic GERD, "must be maintained on treatment. This is a disease and it requires chronic treatment." He says that "the longest trial of [proton pump inhibitors] -- 11 years -- confirms that patients can remain on the drug and remain symptom-free."