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Ask the Allergist | How Can Asthma be Controlled When One is Suffering From GERD 
 
 
Q: How can asthma be controlled when one is also suffering from GERD?

A: GERD, or Gastro-Esophageal Reflux Disease, triggers or worsens respiratory symptoms in a number of people with asthma.  Once the GERD is controlled, asthma often improves - leading to a reduction in medication required and allowing easier breathing.  

GERD is a common condition in which the acid from the stomach flows up the esophagus causing irritation and inflammation. This is often felt as a burning sensation in the upper abdomen and can lead to a bad taste in the mouth and a sense of burning in the chest if the fluid rises high enough. Since the nerves in the lower esophagus are connected to the nerves in the lungs, it is common for acid reflux to trigger asthma symptoms so it is important to control the reflux as much as possible.  

The most important way to control reflux is to first see a doctor to make sure that reflux is the correct diagnosis, as other conditions can mimic it. The treatment for GERD itself is the same as if one did not have asthma.  In many cases a simple trial of an acid reducer such as ranitidine, which is available over the counter, might control the symptoms. Stronger medications called proton pump inhibitors also can reduce acid secretion.  From a dietary standpoint, it helps to avoid eating meals for several hours before bedtime (avoiding large evening meals) and to reduce fat intake.  Alcohol consumption in excess and caffeine can also predispose to acid reflux. Sleeping on several pillows with the upper body propped up to let gravity keep the fluid down may help.  Weight loss for those who are overweight is recommended, as weight gain can worsen reflux.

It is also important to assess whether certain asthma medications may be worsening GERD.  Asthma medications that could increase reflux include theophyllines and oral steroids, and should be used only if there are no other alternatives.  For most who suffer from both conditions, asthma can be controlled with the usual asthma therapies along with treatment of GERD. 

If these simple measures don't work, then more extensive evaluation and treatment may be needed.  Sometimes, medical therapy is not adequate and GERD will require a surgical repair.  Further evaluation should be done under the supervision of a qualified physician.

 
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