Asthma And Heartburn Relationship
There is a mutual cause-and-effect relationship between asthma and GERD. In some situations, reflux disease can actually cause the asthma, particularly adult-onset asthma. In other cases the GERD can potentiate existing asthma, making it difficult to control. In addition, asthma symptoms such as cough and wheezing magnify the difference in pressure between chest and abdomen , encouraging GERD.
The Reciprocal Relationship Between Gerd And Asthma
Theres no clear consensus as to why the two diseases so often come together, but experts suspect that each disease can create the conditions for the other to flare up.
Acid Can Interfere With Airways
As acid backs up into the esophagus, it can damage the lining of the throat and airways, and eventually, strain the lungs. Initially, the effects may be mild some shortness of breath and throat irritation but in time, a chronic cough could develop.
Chronic reflux may also trigger a nerve response that causes the esophagus and airways to narrow in an attempt to keep acid from entering the throat. When this happens, you may struggle to inhale deeply, or feel breathless and wheezy.
Asthma Treatment Can Trigger Reflux
Certain common asthma medications, namely theophylline and bronchodilators, are known to cause acid reflux. These can interfere with the pressure of the esophageal sphincter , the mechanism that keeps the stomach acid from moving back up into the esophagus.
Asthma and GERD are very different disorders, although sometimes they are mistaken for each other. If your asthma isnt responding well to conventional medicine, or you begin to develop symptoms in adulthood, your doctor should check to see if chronic acid reflux is at play.
Studies That Monitored Oesophageal Ph In Patients With Asthma
We identified 32 studies in which oesophageal pH monitoring was performed in patients with asthma. Nine studies were included in the analysis ,,,,,, all of which were cross-sectional and had a secondary care setting. The pooled sample-size weighted average prevalence of abnormal oesophageal acid exposure in asthma patients was 50.9%. Only one study included a control group, but that study did not report the prevalence of abnormal acid exposure among the controls. Without any measure of the prevalence of abnormal acid exposure among controls, such as patients seen in a clinic other than an asthma clinic, it is not clear from the studies whether the rate of abnormal oesophageal acid exposure is higher than expected among patients with asthma or not. In total, 23 studies were excluded .,,,, All but one of the nine included studies reported medication use, and bronchodilators were widely used.
Five studies also reported, as sub-analyses, the prevalence of abnormal oesophageal pH particularly in asthma patients without the typical symptoms of GORD of heartburn and/or acid regurgitation, giving an overall prevalence of 1050%.,,,, In one study, significant predictors of abnormal pH were nocturnal asthma symptoms and hoarseness . The frequency of symptoms was not, however, described by the authors. Another study specifically reported the frequency of night-time asthma symptoms, but found no significant difference between patients with normal and abnormal oesophageal pH.
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Symptoms Of Gord In Patients With Asthma
We identified a total of 22 studies that reported the presence of symptoms of GORD in patients with asthma. Eight studies satisfied our criteria, and are detailed in .,,, Fourteen studies were excluded from the analysis, as described in .,, Among the included studies, one was based on a large primary care administrative database and seven were performed in secondary care settings . Most of the studies were cross-sectional , whereas the database study was a longitudinal cohort study with nested casecontrol analysis. The pooled sample-size weighted average prevalence of GORD in asthma from the seven cross-sectional studies was 59.2%. The Montreal definition of GORD recommends that moderate heartburn and/or regurgitation at least weekly should be used as a cutoff point for disease in epidemiological studies, and this has been employed in a recent systematic review. When we only included those studies that reported the prevalence of at least weekly heartburn and/or acid regurgitation , the average prevalence of GORD was 58.4%. Three studies reported the prevalence of GORD in controls, with an average prevalence of 38.1%. Pooling the odds ratios from these studies gave an overall odds ratio of 5.45 . At least 90% of patients with asthma used bronchodilators in the three studies in which this was reported.,, In the cohort study based on a large UK primary care database, the current use of oral or inhaled steroids was associated with a non-significant increased risk of GORD.
What To Do When You Have Gerd And Asthma
If GERD makes asthma symptoms worse, and asthma medication makes GERD worse, how do you break the cycle? Often the answer is to focus on your GERD and get it under control. Once your acid reflux goes down, your asthma symptoms will likely get better.
Your doctor can help you decide whether you need medication for your GERD symptoms. TheyÃ may suggest you start with over-the-counter medicines like:
- Antacids, which neutralize acid in your stomach
- H2 blockers, which keep your body from making as much acid
- Proton-pump inhibitors, which can reduce the amount of acid your body makes
Sometimes, though, you need prescription medication to get GERD symptoms under control. In rare cases, your doctor will suggest surgery for GERD.There are also things you can do at home to ease your GERD symptoms, like:
- Sleep with the head of your bed raised 6 to 8 inches so that gravity can help your stomach acid stay in your stomach.
- Don’t eat for 3 to 4 hours before you lie down to sleep at night.
- Eat small meals throughout the day instead of three large meals.
- Lose extra weight that may put pressure on your belly.
- Stay away from fatty and acidic foods.
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Asthma And Acid Reflux Attack
Asthma and Acid Reflux can combine to create a respiratory marriage thats hard to break up. Were picking up on our and digging deeper. We once again want to bring you information to help when asthma and acid reflux hitchhiker attack.
Medication and Proper Foods Can Relieve Your Symptoms of Asthma and Acid Reflux disease.
Asthma VS Acid Reflux, a Heartbreaker:
Is there a link between Acid Reflux and Asthma?
In this blog article How do the worlds of asthma and acid reflux get together and what does it mean? First, we will explore a possible link between asthma and acid reflux. Secondly, we will learn how acid reflux creates discomfort. Thirdly, we will then arm you with a list of foods to ease the heartburn symptoms so they wont trigger your asthma.
A Burning Connection and a Bad Romance
Wait, are youre wondering why it is so bad when asthma and acid reflux team up? One asthma acid reflux sufferer describes it this way, Its like your throat has been slit and someone has poured acid down it. She added, Add that burning to the classic shortness of breath, tightness in the chest and wheezing of a regular attack. Additionally, You have the recipe of symptoms that cause a fiery choking as well as a struggle to breathe.
A Link of Two Triggers
How Could Reflux Provoke Asthma Symptoms
Although researchers admit that the evidence is often conflicting and more studies need to be done into the connection between the 2 conditions, they have 2 main theories for how GORD could provoke asthma symptoms.
- During reflux of stomach contents into the oesophagus and throat, stomach acid may get into the airways, causing irritation and inflammation, which in turn may cause tightening of the airways and provoke an asthma attack.
- Stomach acid in the oesophagus, as it inflames and sometimes ulcerates into the tissue, may expose nerve endings and over-stimulate the vagus nerve, which supplies both the oesophagus and the lungs. Over-stimulating the vagus nerve might cause lung airway muscles to go into spasm as they do in an asthma attack.
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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.
Subsets And Special Considerations
Regarding the common complaint of cough that occurs in both asthma and GERD, the EPR-3 guidelines describe a form of asthma known as cough-variant asthma. This form of asthma tends to occur mostly in young children and the principle complaint is a chronic cough. The diagnosis of cough variant asthma is confirmed by a positive response to asthma medication.1 OSA is often added to asthma and GERD as another comorbid condition. In the discussion of OSA/asthma/GERD, it is thought that OSA may promote GERD and thus make asthma worse by triggering bronchospasm through stimulation of the vagus nerve.6 OSA also causes a similar increase in the pressure gradient across the esophageal sphincter as described earlier in bronchospasm resulting in an increased risk of having reflux occur as the patient tries to inspire against a blocked airway. Obesity is another special consideration that appears to increase asthma symptoms of its own accord and tends to increase the risk of GERD as well.8
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Managing The Combination Of Asthma And Gerd
Gastroesophageal reflux disease isnt exactly an uncommon illness about 30% of Americans have weekly bouts of heartburn, the principle symptom but those with asthma are at a considerably higher risk. Doctors report that around 75% of asthmatics also suffer from GERD, which makes them more than twice as vulnerable as the rest of the population.
If you are one of the unlucky people who live with both conditions, rest assured that you can get relief. Its important that you tweak your management plan to treat both the GERD and asthma: first learn what they may have in common and how they differ, then take steps to ease the irritation with gentle lifestyle changes and targeted medicine.
Can Acid Reflux Cause Nerve Pain
Acid reflux symptoms can be typical or atypical in nature. Tingling limbs and nerve pain are considered rare and atypical acid reflux symptoms.
Dr. Mark Babyatsky, a former department chairman at Mount Sinai School of Medicine in New York, that inflammation from acid reflux can reach the lungs and trigger pneumonia.
As a result, the diaphragm can become inflamed, affecting the phrenic nerve, which is a nerve connecting the neck, lung, heart, and diaphragm. In this scenario, a patient can feel referred pain in the limbs, specifically the arms and shoulders.
Alternatively, nerve-related issues may be caused by pre-existing neuropathic conditions, leading to acid reflux. An example of this is gastroparesis. Gastroparesis is a form of diabetic peripheral neuropathy characterized by slow digestion. This leads to bloating, heartburn, and vomiting of undigested food.
If youre experiencing acid reflux symptoms with nerve pain, theres a high chance that your nerve pain is not reflux-related, especially if you are experiencing temporary reflux. Get in touch with a medical professional to find a separate diagnosis concerning your nerve pain.
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Will Gerd Treatment Help Your Asthma
Both medical and surgical treatments have been shown to decrease nighttime symptoms, decrease the frequency of asthma exacerbations, and improve the quality of life in asthma patients. Be sure to keep your doctor informed of how you’re feelingbetter or worse. However, if treatment does not improve your asthma symptoms, you and your doctor should consider other causes.
The Relationship Between Gerd And Asthma
Kristi M. Isaac, BS, PharmD, AE-CClinical Assistant Professor of Pharmacy PracticeXavier University of LouisianaNew Orleans, Louisiana
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.
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Stick To Your Treatment Plan
Heartburn may seem like a mild discomfort, and your asthma may not flare up too frequently, but when you suffer from both conditions, your symptoms can get out of hand before you know it. Left untreated, GERD can cause permanent scarring in your throat, even leading to esophageal ulcers or cancer. Likewise, untreated asthma can lead to worsening symptoms and dangerous exacerbations that could put your life at risk.
The best way to stay on a healthy track is to take any and all medications your doctor has prescribed, exactly as prescribed. If you have daily medications, make it a top priority to never miss a day. Finally, be sure to avoid any GERD or asthma triggers, whether they are certain foods, bad habits, or environmental irritants. Luckily, the undeniable connection between asthma and GERD means if you effectively control one, you stand a good chance of managing the other.
Medications That Cause Acid Reflux
Acid reflux, which is usually heralded by heartburn, is unpleasant enough when it occurs only occasionally. For up to 20 percent of American adults, acid reflux is a frequent occurrence that significantly diminishes their quality of life. Obesity, diet, smoking and a variety of other factors have been linked to acid reflux, and your physician may have urged you to address some of these issues. However, if you have not reviewed your medication list, you may be missing a key element in your treatment plan.
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Severityresponse Relationship Between Gord And Asthma
Only three of the studies evaluating the presence of symptoms of GORD in individuals with asthma considered whether the severity of asthma had an impact on the presence, severity or frequency of GORD symptoms. One study from Italy found that a greater proportion of patients with severe asthma experienced at least twice weekly heartburn and/or acid regurgitation than those with mild or moderate symptoms . Reflux symptoms were present in 30% of patients with mild asthma, 46% of those with moderate asthma and 70% of those with severe asthma. In a cross-sectional study from Spain, a composite score for GORD was calculated based on the percentage of time that pH was less than four in upright and supine positions and in total, the number of reflux episodes in total, the number of reflux episodes longer than five minutes and the duration of the longest reflux episode. The value of this composite score was similar in patients with mild asthma , moderate asthma and severe asthma .
Vincent and colleagues found that in patients with GORD, there was a very strong association between the provocative dose of methacholine causing a 20% fall in FEV1 and the number of oesophageal reflux episodes . There were, however, no other correlations between lung function and GORD criteria .
Gastroesophageal Reflux Disease Is A Common Comorbidity For Asthma Sufferers But Many Patients Dont Make The Connection That Control Of Their Asthma Is Tied To Control Of Their Gerd
Many asthma sufferers have comorbid conditions that contribute to the control of their asthma. Gastroesophageal reflux disease, or GERD, is frequently involved with asthma but many patients dont make the connection that control of their asthma is tied to control of their GERD. There are a number of approaches to help these patients deal with GERD. This article will discuss the relationship of asthma and GERD and describe how treatment of the reflux helps dampen the asthma problem.
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Acid Reflux And Asthma
Do you have both acid reflux and asthma? Heartburn can cause asthma because tiny particles of stomach acid trigger an asthmatic response. Sometimes its the other way around, when your medication for asthma worsens your heartburn.
Asthmatic lungs are hypersensitive to stimuli. As soon as they are triggered,they react by swelling and narrowing. Breathing cold air, exercise orallergens can be enough to cause an excessive reaction.
Clinical Course And Complications
Surgical fundoplication may also be helpful in GER-triggered asthma. Surgery should be reserved for asthmatics who have improvement of asthma with medical GER therapy, especially in those who have normal esophageal motility.
Investigators examined predictors of asthma response with GER therapy. Asthma characteristics include difficult-to-control asthma, nonallergic intrinsic asthma, the presence of nocturnal asthma, and obesity with a BMI of > 29.7 kg/m2.21, 74, 99, 100 Characteristics of GER have also been found to be positive predictors for asthma response in GER-triggered asthma. These include reflux-associated respiratory symptoms, regurgitation more than twice weekly, proximal acid on esophageal pH testing, and abnormal amounts of distal acid on esophageal pH testing.83, 100, 101, 102
Long-term follow-up evaluation of GER-triggered asthma was examined by Sontag and colleagues103 for up to 19 years in 16 surgically treated patients. There was an immediate and sustained reduction in acute nocturnal exacerbations of wheezing, coughing, and dyspnea. By 2 years, there was marked improvement in asthma in up to 75% of patients. There are no data examining long-term asthma outcomes in medically treated patients with PPIs.
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