Asthma and Acid Reflux « Allergies and Asthma

Once a year, the largest pulmonary meeting in the world is held by the American Thoracic Society (ATS). This year, it was in San Francisco, with over 16,000 attendees. One of the major topics is asthma. I reviewed all of the asthma abstracts (short summaries of research done during the previous year), so during the next couple of months, I will blog about some of the highlights from the ATS meeting.

40% of patients with cough variant asthma (CVA) have acid reflux (GERD). Both of these disorders are common, but how common depends on exactly how one defines mild disease and how many medical tests are done to confirm an abnormality and rule out other possible causes for the symptoms of cough and heartburn.

For decades, people who over-indulged with food got heartburn and just treated it with cheap antacids, like TUMS. Then expensive, and somewhat more powerful acid-blocker pills became available. An a couple of years ago, an even more expensive proton pump inhibitor (PPI) that blocks all stomach acid production went off-patent and over-the-counter.

Now patients with heartburn symptoms are sought by multi-million dollar ad campaigns, which suggest that only an expensive PPI should be used for GERD.

Over half of people with asthma are over-weight. Obesity makes acid reflux much more likely. Both asthma and GERD can cause a chronic cough; therefore, asthma and GERD often co-exist. GERD can sometimes (but certainly not more than half of the time) worsen asthma.

So should everyone with asthma and a chronic cough take a PPI every day? Should everyone with a chronic cough get a 500 dollar, 24 hour pH test for acid reflux?

I think that a more reasonable approach is to try a PPI for several weeks to see if it makes a substantial reduction in coughing and generally improves asthma control. For an objective comparison, you should maintain a daily asthma symptom diary for two weeks before you start the PPI and for two weeks while using the PPI.

Please help others by posting your experience on our WebMD asthma message board.