|
Q: I have heartburn; can it worsen my asthma?
A: Asthma symptoms are often improved when GERD is treated. Gastro-esophageal reflux disease (GERD) is very common at all ages in the general population, and even more common in people with asthma. GERD may cause a sour taste after eating, or heartburn, especially when lying down after a large meal, but may cause no symptoms at all. When people with asthma and GERD are successfully treated for GERD, more than two-thirds have less severe asthma symptoms and their need for asthma medications is reduced.
GERD is usually diagnosed by primary care providers according to your history of typical acid reflux symptoms, and confirmed by a reduction in those symptoms in response to anti-acid therapy. However, the "gold standard" for diagnosis, as performed by GI specialists, is placement of a pH probe through your nose into your lower esophagus, with monitoring for 24 hours. Unfortunately, this test is usually reserved for research studies, when surgery is contemplated, and for rich people who insist upon it.
As with asthma therapy, there are several levels of therapy for GERD: if over-the-counter antiacids don't work, then H2 blockers (such as Pepcid, Tagamet, or Zantac) are tried, and if those don't work, then a proton pump inhibitor (PPI), such as omeprazole (Prilosec) or lansoprazole (Prevacid) is tried, and if that doesn't work, then the dose is doubled, and if that doesn't work, surgery (fundoplication) is considered. One study of GERD therapy in patients with moderate to severe asthma found that they often required more than the usual starting dose of omeprazole (>20 mg/day) for up to 3 months before their GERD was supressed and their asthma control improved.
|
