Heartburn and asthma

It is common for patients with asthma to also experience frequent heartburn, a condition called gastro oesophageal reflux disease ( GORD). People with asthma are twice as likely to have GORD as those people who do not have asthma. Of the people with asthma, those who have a severe, chronic form of asthma that is resistant to treatment are most likely to also have GORD.

GORD is the chronic backward flow of stomach acids into the oesophagus (the swallowing tube). Usually, stomach acid is kept in the stomach by a valve at the bottom of the oesophagus called the lower oesophageal sphincter. Sometimes, this valve becomes faulty. When this acid enters the lower part of the oesophagus, it can produce a burning sensation, commonly referred to as heartburn. If left untreated, GORD can eventually lead to lung damage, ulcers in the oesophagus, and in some instances Barrett's oesophagus, a condition that may lead to oesophageal cancer.

Does GORD cause asthma?

Although studies have shown a relationship between asthma and GORD, the exact relationship is uncertain. GORD may worsen asthma symptoms, but asthma and some asthma medications may worsen GORD symptoms. On the other hand, treating GORD often helps to also relieve asthma symptoms, further suggesting a relationship between the two conditions.

Doctors most often look at GORD as the cause of asthma when:

• Asthma begins in adulthood, called adult-onset asthma
• Asthma symptoms get worse after a meal, after exercise, or at night or after lying down
• Asthma doesn't respond to the standard asthma treatments

How can GORD affect my asthma?

As previously mentioned, the exact link between the two conditions is uncertain. However, there are a few possibilities as to why GORD and asthma may coincide. One possibility is that the acid flow causes injury to the lining of the throat, airways, and lungs, making inhalation difficult and often causing a persistent cough.

Another potential link to asthma for patients with GORD is that when acid enters the oesophagus, a nerve reflex is triggered, causing the airways to narrow in order to prevent the acid from entering. This will cause a shortness of breath.

Apart from these possible relationships between asthma and GORD, one study showed that there was an increase in the rate of GORD in patients with asthma who were treated with asthma medications known as bronchodilators. However, further studies must be done before the relationship between GORD and these drugs can be fully understood.

What should I do if I have asthma and GORD?

Continue taking medication your doctor has prescribed for you, as well as control your exposure to asthma triggers as much as possible.

Fortunately, many of the symptoms of GORD can be treated and/or prevented by taking steps to control or adjust personal behaviour. Some of these steps include:

• Raise the head of your bed by fifteen centimetres to allow gravity to help keep the stomach's contents in the stomach. (Do not use piles of pillows because this puts your body into a bent position that actually aggravates the condition by increasing pressure on the abdomen.)
• Eat meals at least three hours before lying down and avoid bedtime snacks.
• Eat smaller meals with moderate portions of food.
• Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra kilograms.
• Limit consumption of foods identified as triggering symptoms that may include:
  •  Fatty foods chocolate, peppermint, coffee, tea, colas and alcohol - all of which relax the lower oesophageal sphincter
  • Tomatoes and citrus fruits or juices which contribute additional acid that can irritate the oesophagus
• Give up smoking, which also relaxes the lower oesophageal sphincter.
• Wear loose belts and clothing.

Aside from these steps, over-the-counter antacids can often relieve GORD symptoms. However, if after two weeks these medications do not help with your symptoms, your doctor may prescribe medicine that blocks or limits the amount of stomach acid your body produces. Under rare circumstances, GORD may only be treatable through surgery.