People with asthma are twice as likely as those without asthma to develop the chronic form of acid reflux known as gastroesophageal reflux disease (GERD) at one time or another. In fact, research has shown that more than 75 percent of adults with asthma also have GERD. The exact connection between GERD and asthma isn’t entirely clear. However, researchers have a few theories as to why the two conditions may coincide.
Why GERD May Trigger Asthma
One possibility is that the repeated flow of stomach acid into the esophagus damages the lining of the throat and the airways to the lungs. This can lead to breathing difficulties as well as a persistent cough. The frequent exposure to acid may also make the lungs more sensitive to irritants, such as dust and pollen, which are all known to trigger asthma.
Another possibility is that acid reflux may trigger a protective nerve reflex. This nerve reflex causes the airways to tighten in order to prevent the stomach acid from entering the lungs. The narrowing of the airways can result in asthmatic symptoms, such as shortness of breath.
Why Asthma May Trigger GERD
Just as GERD can make asthma symptoms worse, asthma can exacerbate and trigger symptoms of acid reflux. Pressure changes that occur inside the chest and abdomen during an asthma attack, for example, are believed to aggravate GERD. As the lungs swell, the increased pressure on the stomach may cause the muscles that usually prevent acid reflux to become lax. This allows stomach acid to flow back up into the esophagus.
Heartburn is the main GERD symptom that adults face. In some people, however, GERD can occur without causing heartburn. Instead, symptoms may be more asthmatic in nature, such as a chronic dry cough or difficulty swallowing.
Your asthma may be connected to GERD if:
- asthma symptoms begin in adulthood
- asthma symptoms get worse following a large meal or exercise
- asthma symptoms occur while drinking alcoholic beverages
- asthma symptoms 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 under age 1 will often experience symptoms of acid reflux, such as frequent spitting up or vomiting, with no harmful effects.
In general, infants and young children with GERD will:
- become irritable
- arch their backs often (usually during or immediately following feedings)
- refuse to eat
- experience poor growth (both in terms of height and weight)
In older toddlers and children, GERD may cause:
- repeated regurgitation
- symptoms of asthma, such as coughing, shortness of breath, and wheezing
Until recently, it was believed that controlling "silent" acid reflux with proton pump inhibitors (PPIs), such as esomeprazole (Nexium) and omeprazole (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 medication and those taking a placebo.
Before the study, researchers estimated that between 15 and 65 percent of people with asthma took PPIs to manage GERD symptoms and control severe asthma attacks. Due to the suspected ineffectiveness of these drugs, however, those with asthma may want to consider other medications to treat their condition.
Make sure you talk to your doctor before changing or abandoning your asthma medications. Some medicines that are commonly used to treat asthma, such as theophylline and beta-adrenergic bronchodilators, may aggravate acid reflux.
Lifestyle and Home Remedies
Since certain medications can be ineffective in treating GERD and asthma simultaneously, the best treatment for these conditions may consist of lifestyle and home remedies.
Controlling GERD Symptoms
To help control or prevent GERD symptoms, you can try:
- losing excess weight
- quitting smoking
- avoiding foods or drinks that contribute to acid reflux, such as:
- alcoholic or caffeinated beverages
- citrus fruits
- fried foods
- spicy foods
- high-fat foods
- tomato-based foods, such as pizza, salsa, and spaghetti sauce
- eating smaller meals more often instead of eating larger meals three times a day
- eating meals at least three to four hours before bedtime
- using a wedge pillow or raising the head of the bed 6 to 8 inches by placing blocks underneath bedposts
- wearing loose clothing and belts
When these 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 foods that can trigger acid reflux (noted above)
Controlling Asthma Symptoms
To relieve asthma symptoms, you may want to consider trying:
- ginkgo extract
- natural herbs, such as butterbur and dried ivy
- fish oil supplements
- deep breathing exercises
Make sure to consult with your doctor before you try any herbs, supplements, or alternative treatments. Your doctor may be able to recommend an effective treatment plan that can help prevent your asthma and GERD symptoms.