Acid Reflux and Asthma

People with asthma are nearly twice as likely as those without asthma to suffer from the chronic form of acid reflux known as gastroesophageal reflux disease (GERD). In fact, research has shown that more than 75 percent of adults with asthma also have GERD.

Although the connection between the two conditions isn’t entirely clear, researchers believe that the stomach acid that backs up into the esophagus damages the lining of the throat and the airways to the lungs over time. This can lead to breathing difficulties and a persistent cough.

The acid may trigger a nerve reflex, which causes airways to narrow and prevents the acid from entering the throat. This can also result in asthmatic symptoms. Whatever the reason, according to the Mayo Clinic, one thing is known for sure: acid reflux can make asthma symptoms worse and asthma can exacerbate symptoms of acid reflux.

Symptoms

The predominant symptom of GERD in adults is frequent heartburn (acid indigestion). However, in some adults and most children, GERD will occur without heartburn. Instead, symptoms may appear in the form of asthmatic symptoms such as a chronic dry cough or difficulty swallowing. Some clues that your asthma may be connected to GERD include:

  • asthma symptoms that begin in adulthood
  • asthma symptoms that worsen following a large meal or exercise
  • asthma symptoms that occur while drinking alcoholic beverages
  • asthma symptoms that happen at night or while lying down
  • asthma medications are less effective than usual

It can be difficult to identify symptoms of GERD in children, especially if they’re very young. Infants less than one year old will often experience symptoms of acid reflux—such as frequent spitting up or vomiting—with no ill effects. However, in older toddlers and children, GERD may present as:

Infants and young children may:

  • become irritable
  • arch their backs (usually during or immediately following feedings)
  • refuse to eat
  • experience poor growth

Treatments

Until recently, it was believed that controlling "silent" acid reflux with proton pump inhibitors (PPIs) such as Nexium and Prilosec would help relieve asthmatic symptoms as well. However, a 2009 study published in the New England Journal of Medicine questioned the drugs' effectiveness in treating severe asthma attacks. During the nearly six-month-long study, there was no difference in the rate of severe attacks between people taking a medication and those taking a placebo. "This was quite unexpected," said Nicola Hanania, a study collaborator from Baylor College of Medicine in Houston, Texas.

Before the study, researchers estimated that between 15 and 65 percent of patients with asthma took the heartburn drugs to control severe asthma attacks. Certain asthma medications—including theophylline (Theo-34 and Elixophyllin, among others) and beta-adrenergic bronchodilators—may worsen acid reflux. Consult your doctor before changing or abandoning your asthma medications.

Lifestyle Changes

Due to the ineffectiveness of certain medications when treating acid reflux and asthma together, the best treatment may be to control symptoms of GERD with lifestyle changes, such as:

  • losing excess weight
  • quitting smoking
  • avoiding foods that contribute to acid reflux, including alcoholic or caffeinated beverages, chocolate, citrus fruits, fried and fatty foods, garlic, mint such as peppermint and spearmint, onions, spicy foods, and tomato-based foods such as pizza, salsa, and spaghetti sauce
  • eating smaller meals more often
  • eating meals at least three to four hours before bed
  • avoiding bedtime snacks
  • avoiding asthma triggers as much as possible

Other steps that may help to control GERD include:

  • raising the head of the bed six to eight inches by placing blocks underneath bedposts (extra pillows are ineffective)
  • wearing loose clothing and belts
  • taking over-the-counter antacids

When other strategies and treatments don’t work, surgery is usually an effective last resort in treating GERD.

Controlling Acid Reflux in Children

A few easy strategies for avoiding acid reflux in children include:

  • burping infants several times during feeding
  • keeping infants in an upright position for 30 minutes after feeding
  • feeding children smaller, more frequent meals
  • not feeding children the foods noted above