GERD and Asthma: What’s the Link?

Although these conditions are separate, they often occur together. “GERD-related asthma refers to asthma symptoms that are triggered or worsened by GERD,” says Ricardo A. Medina-Centeno, MD, a pediatric gastroenterologist and the medical director of the neurogastroenterology and motility program at Phoenix Children’s Hospital in Arizona. In GERD-related asthma, stomach acid or other contents flow up through the esophagus and sometimes reach the throat and the airways, causing muscles around the airways to tighten and leading to asthma symptoms like coughing, wheezing, and shortness of breath.

The GERD and asthma connection is well-documented but still not totally understood. Read on to learn more about why GERD and asthma often occur together, which symptoms to look out for, and questions to ask your doctor if you believe you may have the condition.

Although it’s typically called GERD-related asthma or GERD-induced asthma, Dr. Martin says that the relationship between the two conditions is probably bidirectional, meaning that the two conditions may induce or exacerbate each other, instead of one simply causing the other. “Studies have shown asthma to be more prevalent in patients with GERD compared to patients without GERD, and other studies have shown that GERD is more prevalent in patients with asthma compared to patients without asthma,” he says.

Patients with GERD-related asthma will likely have some typical or atypical reflux symptoms, according to Martin. These include:

• A burning sensation in the chest or throat (also called heartburn)
• Regurgitation of gas, liquid, or solid food
• Sore throat or a hoarse voice
• Cough
• Feeling of having a lump in your throat when nothing is there (also called globulus sensation)

Someone with GERD-related asthma might experience additional symptoms, including:

• Wheezing
• Shortness of breath
• Chest tightness, especially after eating
• Obstructed airways (in severe cases)

“In GERD-related asthma, symptoms are often triggered or worsened by eating, lying down, or bending over, while in asthma without GERD, triggers are usually allergens, cold air, exercise, or respiratory infections,” Medina-Centeno says, referring specifically to the second set of symptoms listed above that are more characteristic of asthma. These symptoms are more common at night or after meals in cases of GERD-related asthma, while they can happen anytime in asthma without GERD.

“Currently, there are no specific tests or biomarkers that can definitively diagnose GERD-related asthma,” Martin says. If your doctor suspects that you have the condition, it’s likely they'll order the following tests, screenings, and assessments.

Medical History, Symptom Assessment, and Physical Exam

Medina-Centeno explains that your doctor will likely start by reviewing your asthma and GERD symptoms, then ask when they occur and whether they’re worse when you eat or lie down. They’ll also review your asthma history (if you have one), including any known triggers and the effectiveness of any medications you’re on. Then, they’ll perform an in-office physical examination that focuses on the respiratory and digestive systems.

GERD Testing

To determine whether or not you have GERD, your primary care physician will refer you to a gastroenterologist who may perform certain tests, including:

• 24-hour esophageal pH monitoring: “This test measures the amount of both acidic and non-acid reflux in the esophagus over a 24-hour period,” Medina-Centeno says. “A small probe is placed in the esophagus to record acid levels. This test can confirm the presence of acid reflux and its correlation with asthma symptoms.”
• Upper endoscopy (EGD) “A flexible tube with a camera is inserted through the mouth to visually inspect the esophagus, stomach, and the first part of the small intestine,” Medina-Centeno says. “This can help identify inflammation, erosion, or other signs of GERD.”
• Esophageal manometry “This test measures the rhythmic muscle contractions of the esophagus when swallowing,” Medina-Centeno says. “It can help assess the function of the lower esophageal sphincter, which is often involved in GERD.”

Asthma Testing

To get a GERD-related asthma diagnosis, you’ll also need to see a pulmonologist who can run tests on your lung function. Pulmonary function tests (PFTs) are a set of noninvasive tests that measure your lung volume and capacity, how well your lungs breathe air in and out, how effectively oxygen is transferred to your blood, and other key measures that can diagnose asthma and other pulmonary conditions.

Once these tests have been performed, a pulmonologist or allergist may diagnose GERD-related asthma. It’s important to have a gastroenterologist involved as well, Martin says, since treatment often includes both asthma and GERD medications.

Depending on your symptoms and their severity, doctors will recommend certain treatments for managing GERD with asthma. Many of these treatments are the same as those used for GERD without asthma, and some are more specific to asthma symptoms. Here are the most common treatments.

Proton Pump Inhibitors (PPIs)

“These reduce the amount of acid your stomach produces, helping to prevent acid from irritating your esophagus and potentially triggering asthma symptoms,” Medina-Centeno says. They’re a common GERD treatment used for people with and without asthma.

H2 Blockers

“These decrease acid production in the stomach, though not as strongly as PPIs,” Medina-Centeno says. “They can be used for milder symptoms or in combination with other treatments.”

Antacids

These over-the-counter medications (such as Tums) can neutralize stomach acid and provide short-term relief. “They are often used for immediate symptom relief but not as a long-term solution,” Medina-Centeno says.

Inhalers

If the above GERD treatments don’t eliminate asthma symptoms, a pulmonologist may prescribe corticosteroid or albuterol inhalers to manage symptoms like coughing, wheezing, difficulty breathing, and shortness of breath, Martin says.

Dietary Modifications

Although there’s not a specific “GERD diet” that everyone needs to follow, spicy foods, chocolate, caffeine, alcohol, and fatty foods are common triggers for GERD, so your doctor may recommend that you avoid them, Medina-Centeno says. Eating smaller, more frequent meals instead of larger ones and avoiding food within a few hours of bedtime can also help reduce acid reflux, he says.

Adjusting Your Sleep Position

“Elevate the head of your bed by about 6 to 8 inches to help prevent acid from flowing back into the esophagus while you sleep,” Medina-Centeno says.

Avoiding Asthma Triggers

Lifestyle habits like smoking and certain allergens can trigger asthma symptoms. An allergist can help you determine which allergens you may be sensitive to.

While more research is needed, experts believe that the connection between GERD and asthma goes both ways. GERD may cause asthma because when stomach contents flow into the esophagus, asthma symptoms like constricted airways and coughing may be triggered. On the flip side, asthma may trigger GERD by weakening the lower esophageal sphincter over time, which lets stomach contents to leak up into the esophagus.