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Can Heartburn Cause Asthma Symptoms

Can Acid Reflux Cause Worsening Of Asthma Symptoms

Asthma and Reflux

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The Relationship Between Gerd And Asthma

Kristi M. Isaac, BS, PharmD, AE-CClinical Assistant Professor of Pharmacy PracticeXavier University of LouisianaNew Orleans, Louisiana

US Pharm.

Asthma is a chronic airway disease characterized by airflow obstruction, bronchial hyperresponsiveness, and inflammation.1 There are many triggers and comorbid conditions that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations. The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma recognizes gastroesophageal reflux disease as a comorbid condition of asthma and recommends medical management of GERD in appropriate patients.1

The relationship between asthma and GERD has been discussed for many years. In 1892, Sir William Osler described an association: severe paroxysms of asthma may be induced by overloading the stomach, or by taking certain articles of food.2 Although these two disorders often occur together, the relationship between GERD and asthma remains unclear. This article will review the prevalence, proposed pathophysiology, and treatment recommendations for persons with both asthma and GERD.

Ear And Sinus Problems: Common Or Worrisome

GERD is one of the most common gastrointestinal conditions in the U.S. but its symptoms arent always straightforward. More and more physicians are accepting its association with ENT conditions.

Although its difficult to explain how GERD mechanisms affect the ear and sinus, doctors suggest that damages caused by GERD can change how the ear and nose behave.

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What Are The Causes Of Reflux Related Adult Onset Asthma

GERD can cause asthma-like symptoms via two mechanisms:

  • Aspiration of acid particles in the trachea can cause coughing, wheezing and pneumonia
  • Acid in the esophagus causes a reflex phenomenon in the trachea, triggering asthma-like symptoms

Thus, it is important for physicians to consider the possibility of GERD when treating patients with lung problems.

How Asthma Can Promote Reflux

Gastroesophageal Re

Strong coughs, like that occurring in asthma, can promote reflux. The mechanism is not understood in detail, but it seems likely that coughing causes a relaxation of the valve at the lower end of the esophagus, the lower esophageal sphincter. The sphincter acts as a barrier against reflux, and so when it is relaxed, reflux can pass through it more easily.

Asthma medications can also favor the development of reflux. -agonists and theophylline are commonly prescribed medications against shortness of breath, and they can cause a relaxation of the esophageal sphincters.

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The Connection Between Heartburn And Asthma Explained

It is believed that more than 80% of asthma patients also suffer from recurrent heartburn, a condition known as gastroesophageal reflux disease . People who have asthma are twice as likely as those who do not have asthma to have GERD.

Doctors arent sure why the two are so closely related, but they know it has something to do with stomach acid and your airways.

Is Gerd Dangerous Or Life

GERD isnt life-threatening or dangerous in itself. But long-term GERD can lead to more serious health problems:

  • Esophagitis: Esophagitis is the irritation and inflammation the stomach acid causes in the lining of the esophagus. Esophagitis can cause ulcers in your esophagus, heartburn, chest pain, bleeding and trouble swallowing.
  • Barrett’s esophagus: Barrett’s esophagus is a condition that develops in some people who have long-term GERD. The damage acid reflux can cause over years can change the cells in the lining of the esophagus. Barretts esophagus is a risk factor for cancer of the esophagus.
  • Esophageal cancer: Cancer that begins in the esophagus is divided into two major types. Adenocarcinoma usually develops in the lower part of the esophagus. This type can develop from Barretts esophagus. Squamous cell carcinoma begins in the cells that line the esophagus. This cancer usually affects the upper and middle part of the esophagus.
  • Strictures: Sometimes the damaged lining of the esophagus becomes scarred, causing narrowing of the esophagus. These strictures can interfere with eating and drinking by preventing food and liquid from reaching the stomach.

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Do You Have Laryngopharyngeal Reflux

Laryngopharyngeal reflux or LPR is a type of esophageal reflux that doesnt involve the tell-tale sign of GERD: heartburn. As a result, patients have a difficult time understanding the nature of their symptoms. In most cases, patients with LPR dont even know they have reflux, which is why the disorder is called silent reflux.

LPR is caused by the same mechanism that triggers GERD. When the lower esophageal sphincter loosens, stomach contents travel back up the esophagus. In this case, stomach acids travel further up the pharynx, reaching the larynx and nasal pathways. As a result, a patient with LPR experiences symptoms like:

  • Chronic cough
  • Difficult swallowing feeling of persistent lump in the throat
  • Post-nasal drip

Does Gerd Trigger Asthma

Silent GERD May Cause Asthma, Chronic Cough, but no Heartburn. Why?

As stomach acid repeatedly travels into the esophagus, it can damage the lining of the throat and the airways to the lungs. This can result in both a nagging cough and difficulty breathing.

When the lungs are consistently exposed to acid, it can also cause them to be more sensitive to irritants like dust and pollenwell known asthma triggers.

Another reason the two conditions may be linked is that acid reflux has been known to trigger a protective nerve reflex. In order to keep stomach acid from entering the lungs, this reflex forces the airways to tighten.

In some cases, this tightening can result in shortness of breath, a common asthmatic symptom.

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The Link Between Gerd And Asthma

Researchers have also identified a link between GERD and asthma. A 2019 study suggested a bidirectional relationship between GERD and asthma. This means that people with GERD may be more likely to have asthma, and people with asthma may be more likely to experience GERD.

In fact, a 2015 study estimates that up to 89% of people with asthma also experience GERD symptoms. The reason for this may be due to how acid interacts with the airways. Acid in the esophagus sends a warning signal to the brain, which triggers the airways to contract. This, in turn, triggers asthma symptoms.

In cases of GERD-related asthma, treating the symptoms of GERD may help alleviate the symptoms of asthma.

As a 2016 review notes, asthma may also trigger GERD. During an asthma attack, the airways tighten, causing pressure in the esophagus. This increased pressure could encourage acid to leak into the esophagus.

Sometimes, it may be difficult to tell whether a persons symptoms are the result of asthma or GERD. For instance, a

Untreated or unmanaged GERD can lead to numerous health complications. Some examples include:

Gerd Causes Direct Bronchospasm

This interesting theory postulates that the esophagus and bronchioles share some of the same nerves. Microscopic amounts of acidic stomach content enters the airway and irritates your esophagus. A signal is then sent via nerve pathways to bronchioles thereby irritating them and causing them to spasm . This is how acid reflux may indirectly cause bronchospasm, or so the theory goes. This mechanism is referred to as the vagally mediated reflex.5This theory essentially asserts that acidic stomach contents do not have to be inhaled into the lungs to cause asthma, all it has to do is irritate the esophagus.6 This response may also be a natural response to prevent pathogens from entering the airways .

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Treating Reflux To Help Treat Asthma

Doctors believe that some people who have asthma and symptoms of reflux might benefit from being treated with anti-reflux medicine to see if their asthma improves. Other techniques that may help reflux are avoiding eating and drinking in the 2-3 hours before you go to bed , and raising the head of your bed on blocks of about 15-20 cm.

However, although some studies have shown that asthma symptoms improve after treatment for reflux in some people with asthma, lung function itself does not seem to get any better.

Evidence for the effectiveness of this treatment is still under discussion.

What Can You Do

Asthma Caused By Gerd Symptoms

If you suspect you have reflux-related asthma symptoms, you should see your doctor. He or she can diagnose your condition and provide a management plan and treatment for you.

Clues that your asthma may be related to reflux are that:

  • you suddenly develop asthma as an adult
  • your asthma is worse at night
  • your asthma gets worse after meals, when you lie down or when you exercise
  • your asthma is hard to control despite treatment.

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Rhinitis And Sinusitis Connection: Rhinosinusitis

The most common causes of chronic nasal congestion are allergic and nonallergic rhinitis inflammation of the nose. Nonallergic rhinitis caused by environmental or occupational irritants. Allergic rhinitis happens when you breathe in something to which you are allergic.

Dust, dander, insect venom, or pollen is only a few of the many triggers for allergic rhinitis. Rhinitis and sinusitis can make your life miserable. Recent studies by doctors have better defined the association between rhinitis and sinusitis. Sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis.

Acid Reflux Or Heartburn

Youre more likely to get acid reflux or heartburn if you have asthma – especially if your asthma is severe or difficult to control.

This is where acid from the stomach leaks out of the stomach up into the oesophagus .

You might get a burning feeling in your chest after eating, a bad taste in the mouth, and find it hard to swallow.

If you keep getting acid reflux or heartburn, its known as gastro-oesophageal reflux disease .

GORD and obstructive sleep apnoea are linked too, so you may have both at the same time.

How GORD can affect your asthma

If you have asthma and GORD, you need to keep a closer eye on your asthma symptoms. They could get worse because of stomach acid irritating your airways.

The things that make heartburn worse – being overweight, drinking alcohol, smoking, and stress – are all common asthma triggers too.

Although its not yet clear whether treating acid reflux improves asthma symptoms, there is some evidence to say it might improve them for some people.

How to lower your risk of symptoms

  • Ask your GP or pharmacist about medicines for acid reflux
  • Keep a food diary to see what makes it worse
  • Ask for help with losing weight
  • Stop smoking

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Does Asthma Trigger Gerd

Weve seen how GERD can trigger asthma, but can asthma trigger GERD? The short answer is yes. When someone is having an asthma attack, there are pressure changes that happen inside the chest and abdomen. It is thought that these changes in pressure may exacerbate GERD.

The increased pressure on the stomach that occurs when the lungs swell can cause the muscles, which typically prevent acid reflux, to become lax, allowing stomach acid to move back up into the esophagus.

Asthma And Other Complications

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GERD can lead to the reflux of fluid into the airways this can result in choking, coughing, or even pneumonia. In some patients, reflux may worsen asthma symptoms. Treating GERD may help improve asthma symptoms in these people. And GERD can be worsened by asthma and by some of the medicines that are used to treat asthma.

GERD can also lead to chronic hoarseness, sleep disturbance, laryngitis, halitosis , growths on the vocal cords, a feeling as if there is a lump in your throat, earaches, and dental problems.

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What Causes The Link Between Gerd And Asthma

The mechanisms behind the association arent crystal-clear, but there are a few theories. One is that if someone has GERD, aspiration of stomach acid into the airways can cause irritation there, leading to breathing difficulties or a persistent cough.

If you have acid reflux and you regurgitate high enough, you can get a bronchospasm that can trigger asthma, Dr. Vaezi notes. Another theory is that acid reflux may trigger a protective nerve reflex that causes the airways to tighten in order to prevent the stomach acid from entering the lungs this can lead to a bronchospasm too.

There isnt a single test that can definitively identify reflux as the cause of asthma-like symptoms in those with GERD. But not responding to steroids is a big red flag to consider GERD in a patient with severe asthma, notes Kaiser Lim, MD, a consultant in pulmonary and critical care medicine at the Mayo Clinic in Rochester, Minnesota. To determine if reflux is exacerbating asthma, doctors typically consider a persons symptoms and their response to treatment. In terms of treatment, a doctor might prescribe aggressive use of acid-suppressing medication to see if the asthma-like symptoms improve, Vaezi says.

Ways To Alleviate Gerd Symptoms

There are several things you can do to yourself to keep your GERD symptoms to a minimum. If you carry excess weight on your body, losing the weight should make a big difference in your symptoms. Stopping smoking has also been known to alleviate GERD symptoms.

  • Beverages that are caffeinated or alcoholic
  • Chocolate
  • Foods that are high in fat
  • Onions
  • Garlic
  • Pizza, salsa or other tomato-based foods

Its also recommended that you eat smaller meals five to six times a day instead of having three large meals each day. If possible, you should also try to eat your last meal three to four hours before you go to bed.

If you have a child who suffers from acid reflux, there are a few things you can try to help relieve the symptoms. When youre feeding your infant, burp them several times and keep them in an upright position for at least 30 minutes after theyre done eating.

As with adults, children should also have smaller meals more frequently and stay away from the list of acid reflux-triggering foods listed above.

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When Do I Need To See The Doctor

If your acid reflux happens more than twice a week or the symptoms are severe, it is time to see a doctor. Equally, if you have tried medications together with lifestyle changes and they dont bring long-lasting relief, you need to consult a healthcare professional. Dont forget to tell your doctor about any medication you are taking because some drugs can cause GERD symptoms.

Because breathing problems and acid reflux can be symptoms of a number of conditions, your doctor may want to run a few tests to get a clear idea. For example, they might need to check for ulcers, physical narrowings in the esophagus, pH levels, and tissue changes.

For this reason, your doctor may recommend an endoscopy and take some samples in order to identify the cause and pick the best treatment for your case.

The doctor may recommend that you start with lifestyle changes, such as quitting smoking and avoiding fatty foods, in combination with anti-reflux medication to manage your problem. In some cases, such as hiatal hernia, surgery may be required.

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Can You Have Acid Reflux And Not Know It

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Acid reflux can manifest in different ways. Other patients may report extreme versions of acid reflux involving constant heartburn and regurgitation, while others might only report trouble swallowing and coughing.

Alternatively, there is another form of esophageal reflux that doesnt exhibit the same symptoms as GERD or heartburn. If youre experiencing classic reflux symptoms such as coughing and sleep apnea, you may be experiencing what is known as silent reflux.

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Can Acid Reflux Cause Chest Pain

Chest pain is one of the most common symptoms of acid reflux. Chest pain related to reflux is also called noncardiac chest pain . Chest pain occurs during reflux episodes because the heart and the esophagus share a nerve network. Acid reflux, specifically GERD, causes up to 66% of reported NCCPs.

Evaluating Your Chest Pain

Since chest pain from acid reflux and more serious conditions such as heart attack are hard to distinguish, its important to know how to evaluate your chest pain. Chest pain from acid reflux often affects the sternum or the area below it called the epigastrium. Pain from acid reflux is often characterized as a sharp pain, which gets worse with coughing.

Meanwhile, chest pain from non-acid reflux sources could be described as a deep, searing pain. Heart-related chest pain often radiates to other parts of the body including the back, neck, shoulders, and arms.

The symptoms that accompany chest pain are also key in evaluating the nature of the pain. Gastro-related chest pain is often accompanied by burping or flatulence, trouble swallowing, bile regurgitation, and a burning sensation in the throat or stomach.

Cardiac-related chest pain is often accompanied by numbness in the left arm or shoulder, shortness of breath, dizziness, and high body temperatures.

Can Gerd Cause Asthma Symptoms

Does GERD cause asthma? Does acid reflux cause shortness of breath? How do you know if your acid reflux is causing asthma? In this section, well explore all of these questions and dig deeper into the link between GERD and asthma. Lets start by describing what asthma typically looks like.

If youre experiencing symptoms like shortness of breath, a whistle or hissing when you inhale or exhale, coughing particularly at night, and tightening or pain in your chest, you may have asthma and should see your doctor. Symptoms can vary from person to person and episodes can range from mild to severe. While the latter needs immediate medical attention, mild symptoms also need the proper care to keep asthma in check.

Interestingly enough, people who are diagnosed with asthma are twice as likely as those without asthma to develop the chronic form of acid reflux, or GERD, at some point or another. Although there isnt enough evidence to state the definitive connection between the two conditions, there are theories as to why GERD can cause asthma symptoms.

One theory concerning the connection between GERD and asthma states that the repeated flow of stomach acid into the esophagus damages the lining of the throat and the airways to the lungs. This damage can lead to breathing difficulties and a chronic cough, and may make the lungs more sensitive to irritants like dust and pollen.

Here are some signs that GERD may be causing asthma, according to Cedars-Sinai:

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