Gastroesophageal reflux disease (GERD) is a condition where stomach contents travel back up the esophagus towards the throat. Asthma is a respiratory condition that affects the airways.
GERD and asthma may trigger each other due to the connection between the esophagus, stomach, and airways, as well as side effects of certain asthma medications.
This article discusses the link between GERD and asthma, treatment for both conditions, and when to contact a doctor.
- Nerves in the lower esophagus connect to nerves in the lungs, which means GERD symptoms may trigger asthma symptoms.
- Small particles from acid reflux can enter the airways and aggravate asthma symptoms.
- Muscles at the base of the esophagus can relax during an asthma flare, causing contents from the stomach to flow back up towards the throat.
- Some asthma medications, such as quick-relief inhalers, may also trigger GERD.
The esophagus is a tube that connects the throat to the stomach. Nerves in the lower part of the esophagus connect to nerves in the lungs, which means acid reflux can trigger symptoms of asthma.
The vagal nerve connects the brain to the stomach and affects multiple organs in the body. Acid reflux triggers the vagal nerve, which causes the lungs to become more sensitive to asthma triggers, such as irritants or allergens.
As contents from the stomach and stomach acid travel back up the esophagus, small particles of acid can also get into the airways. This can trigger asthma symptoms, such as chest tightness.
According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), people who have asthma have a higher risk of GERD.
At the lower end of the esophagus, there are a group of muscles called the esophageal sphincter.
When the esophageal sphincter closes, the muscles prevent stomach acid or contents from traveling back up towards the throat.
During an asthma flare-up, pressure changes occur inside the chest and abdomen. This causes the esophageal sphincter to relax, which can cause stomach acid or contents to travel back into the esophagus.
Some asthma medications, such as theophylline, may also worsen acid reflux. The overuse of quick-relief inhaler medications, such as albuterol, can also trigger GERD. This is because albuterol also relaxes the esophageal sphincter.
Symptoms of GERD can include:
People who have both asthma and GERD may find that treating GERD can help to reduce their asthma symptoms and use of asthma medication.
If a person has symptoms of GERD and moderate to severe asthma, a doctor may advise them to take a proton pump inhibitor (PPI), such as omeprazole or esomeprazole,
A person should take the PPI before breakfast and dinner for it to be effective. Doctors may prefer PPIs over H2 blockers and other over-the-counter (OTC) medications because PPIs prevent gastric acid secretion more effectively.
The treatment of asthma with medications such as theophylline may lower a person’s esophageal sphincter tone and cause GERD symptoms. Doctors may not choose to prescribe theophylline to people with asthma due to its side effects and interactions with other drugs.
Doctors may refer a person to a gastroenterologist if GERD does not improve with twice-daily PPI therapy or if they develop more serious symptoms, such as difficulty swallowing.
Surgical fundoplication is a procedure where surgeons fold and sew the top part of the stomach, or fundus, around the lower esophageal sphincter. This may be appropriate for refractory GERD in selected people.
However, people may still require medical therapy for GERD after fundoplication.
Home treatments to help manage GERD include:
- avoiding eating 2–3 hours before sleeping
- raising the head of the bed by 6–8 inches to elevate the upper body, as just raising the head with extra pillows is not effective
- eating smaller meals and limiting large, heavy meals, particularly before sleeping
- maintaining a healthy weight
- avoiding smoking
Dietary changes may also help, and people may need to avoid:
- acidic foods, such as citrus fruits
- fried foods
- fatty foods
- spicy foods
For children with GERD, the following may help:
- elevating the head of the bed or sleeping on the left side
- avoiding eating just before bedtime
- avoiding second-hand smoke
- maintaining a healthy weight
- only using OTC or prescription medications to treat GERD if a doctor advises
To help control asthma, people may find the following helpful:
- understanding and avoiding personal asthma triggers
- managing stress
- getting the flu vaccine each year
- taking medications as a doctor prescribes
- developing an asthma action plan with a doctor
- avoiding tobacco smoke, including second-hand smoke
- if possible, avoiding outdoor activities when air quality is poor
- cleaning regularly and considering air purifiers to improve indoor air quality
- attending regular checkups
- maintaining a healthy weight
- eating heart-healthy foods, such as plenty of fruit and vegetables, and ensuring adequate vitamin D
- exercising regularly
- maintaining healthy sleep habits
For children with asthma, the following may help:
- always having their quick-relief inhaler with them
- in some cases, taking long-term medication to control inflammation of the airways and reduce the risk of asthma attacks
- getting the flu shot each year
- making sure any child care or school understands the treatment plan and steps to take in case of an asthma attack
People should contact their doctor if they have symptoms of GERD or if symptoms are not improving with treatment, such as medications or lifestyle changes.
People should also contact their doctor if they have any of the following symptoms:
- chest pain
- loss of appetite
- recurrent vomiting
- pain or difficulty swallowing
- any signs of bleeding from the digestive tract, such as blood in the stools or vomit, black and tarry stools, or vomit that resembles coffee grounds
- unintentional weight loss
For asthma, people will need to seek immediate medical help if asthma medications, such as a quick-relief inhaler, do not improve symptoms of an asthma attack or if a peak flow number for breathing is low.
Young children with asthma will need immediate medical attention if they:
- are drowsy, confused, or agitated
- have a change in skin or lip color, such as a bluish tinge
- have a fast heartbeat
GERD and asthma may trigger each other due to the use of asthma medications or the connection between the stomach, esophagus, and airways.
Managing GERD symptoms may help to reduce asthma symptoms, along with taking any steps to manage asthma with medication. Dietary and lifestyle changes can also help to manage both conditions and reduce symptoms.