What is gastro-esophageal reflux disease (GERD), and why does it affect my asthma?

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults. People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms. On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Symptoms

Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth, or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician.

Other symptoms that occur less frequently but can indicate that you could have GERD are:

• Acid regurgitationrn• Difficulty or pain when swallowingrn• Sudden excess of salivarn• Chronic sore throatrn• Laryngitis or hoarsenessrn• Inflammation of the gumsrn• Cavitiesrn• Bad breathrn• Chest pain

The link between asthma and GERD

Researchers have discovered that GERD can trigger asthma symptoms. In addition, GERD is more common in people with asthma than in the general population. Individuals whose asthma is especially hard to treat appear to be more prone to GERD than other affected persons.

Generally speaking, reflux may cause asthma symptoms in two ways.

1) The stomach acid that leaks back into the esophagus creates a chain reaction leading to asthma symptoms. The refluxed gastric acid irritates the nerve endings in the esophagus generating signals to the brain. Subsequently, the brain responds with impulses to the lungs that stimulate the muscle and mucus production in the airways. The small airways of the lungs then constrict, resulting in asthma symptoms. 2) In many cases, physicians believe that the refluxed stomach contents enter the lungs directly. This situation is called aspiration. The foreign material is a potent irritant for the airways, creating wheezing, coughing, chest tightness, and other symptoms of asthma. Some experts believe that asthma also may trigger GERD, when breathing difficulties or certain asthma medications cause the esophageal sphincter muscle to relax and allow stomach contents to reflux — completing a troublesome, potentially vicious cycle.