What is the relationship between asthma and gastroesophageal reflux disease (GORD)?

From the Guidelines

Asthma patients with gastroesophageal reflux disease (GORD) should be treated with lifestyle modifications and proton pump inhibitors (PPIs) to improve asthma symptoms and quality of life. The relationship between asthma and GORD is complex, with acid reflux potentially triggering bronchospasm and worsening asthma symptoms 1. Treatment of GORD in asthma patients may involve avoiding trigger foods, eating smaller meals, not lying down for 2-3 hours after eating, elevating the head of the bed, and maintaining a healthy weight.

• Medication options for GORD include over-the-counter antacids for immediate relief, H2 blockers like ranitidine, or PPIs like omeprazole for more persistent symptoms 2.
• For asthma control, patients should use prescribed inhalers as directed, typically including a daily controller medication and a rescue inhaler as needed.
• The connection between asthma and GORD involves acid reflux potentially triggering bronchospasm when stomach acid irritates the esophagus, creating a vagal reflex that affects the airways.
• Some asthma medications like theophylline or oral steroids may also relax the lower esophageal sphincter, exacerbating GORD.
• If symptoms persist despite these measures, patients should consult their healthcare provider as they may need further evaluation or adjusted treatment 1, 2.

From the Research

Asthma and GORD

• Asthma and gastro-oesophageal reflux disease (GORD) are common medical conditions that frequently co-exist 3.
• GORD has been postulated as a trigger for asthma; however, evidence remains conflicting 3.
• Proposed mechanisms by which GORD causes asthma include direct airway irritation from micro-aspiration and vagally mediated oesophagobronchial reflux 3.

Treatment of GORD in Asthma

• The treatment of GORD in asthmatic patients relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations 4.
• Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life 4.
• Medical treatment for GORD probably improved forced expiratory volume in one second (FEV₁) by a small amount and use of rescue medications 3.
• A proton pump inhibitor, lansoprazole, appears to be useful in improvement of asthma symptoms in asthmatic patients with GORD 5.

Effects of Lansoprazole Therapy

• Treatment with 30 mg of lansoprazole bid for 24 weeks did not improve asthma symptoms or pulmonary function, or reduce albuterol use 6.
• However, this dose significantly reduced asthma exacerbations and improved asthma quality of life, particularly in those patients receiving more than one asthma-control medication 6.
• Lansoprazole, but not roxatidine, significantly improved peak expiratory flow and asthma control questionnaire scores in asthmatic patients with GORD 5.