Masquerading symptoms: Asthma or acid reflux?

Published: Jan. 25, 2019 at 3:51 PM EST
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Coughing, wheezing, crying – asthma is never fun for a child. But now, there are new guidelines for better treatment, unless something else is disguised as asthma.

The Centers for Disease Control and Prevention says about one in 10 children have asthma, and the numbers are only increasing in the U.S.

If your child has asthma, you’re probably familiar with the coughing, wheezing, chest pain and shortness of breath. But now, the American College of Allergy, Asthma and Immunology has created a guideline that helps doctors understand which treatments belong with different age groups and how parents can set up new therapies if the old ones aren’t working.

But some doctors are realizing that children’s asthma symptoms may be something else entirely.

“Reflux is the great masquerader of our time, and it affects millions and millions of children,” Mt. Sinai Medical System Dr. Jamie Koufman said.

Koufman says the junk food given to children at night can make acid reflux look like asthma or allergies.

“If your child always has respiratory symptoms – be it ear symptoms, nose symptoms, cough symptoms, breathing symptoms, allergy symptoms, sinus symptoms, asthma – and they’re not getting better and it goes on and on and on, think respiratory reflux,” she said.

Acid reflux symptoms do not always include heartburn; it can present as chronic dry cough or difficulty swallowing.

Talk to your doctor if you have any concerns.



REPORT #2599

BACKGROUND: Asthma causes swelling of the airways. This results in narrowing of the airways that carry air from the nose and mouth to the lungs. Allergens or irritating things entering the lungs trigger asthma symptoms. Symptoms include trouble breathing, wheezing, coughing and tightness in the chest. Asthma can be deadly. According to the Centers for Disease Control and Prevention (CDC), 1 in 13 people have asthma. Asthma is more common in children than adults and currently, there are about 6 million children under the age of 18 with asthma. Gastroesophageal reflux disease (GERD) is a chronic condition that affects the digestive system. While most people experience heartburn or indigestion from time to time, if you feel that burning sensation in your chest more than twice a week, you might have GERD. The condition is a more serious and long-lasting form of acid reflux. Most people can manage GERD with over-the-counter (OTC) medications and a few lifestyle changes. Reflux is the cause of much respiratory disease. More commonly still, it is the unrecognized agent provoking the symptoms of respiratory disease.

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GERD AND ASTHMA: It is estimated that more than 75 percent of patients with asthma also experience gastroesophageal reflux disease (GERD). People with asthma are twice as likely to have GERD as those people who do not have asthma. Of the people with asthma, those who have a severe, chronic form that is resistant to treatment are most likely to also have GERD. Although studies have shown a relationship between asthma and GERD, the exact relationship is uncertain. GERD may worsen asthma symptoms, but asthma and some asthma medications may in turn worsen GERD symptoms. However, treating GERD often helps to also relieve asthma symptoms, further suggesting a relationship between the two conditions. The exact link between the two conditions is uncertain. There are a few possibilities as to why GERD and asthma may coincide. One 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 possibility for patients with GERD is that when acid enters the esophagus, 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.


HOW TO CONTROL GERD AND ASTHMA: Getting good control over one of these conditions can help improve symptoms and minimize flare-ups of the other one. “If you have one triggering the other, by treating one, you’re treating the other. You’re breaking the cycle by taking one element away,” Michael Vaezi, MD, a professor of medicine and otolaryngology and director of the Swallowing and Esophageal Disorders Center at Vanderbilt University Medical Center in Nashville, says. Those who have nocturnal asthma and heartburn are more likely to respond to proton pump inhibitors (PPIs) and their asthma is more likely to get better as a result, he adds. But in a subset of people with severe asthma, GERD treatments could actually worsen their breathing troubles. A study in the September 2017 issue of the Journal of Clinical Immunology found that people with difficult-to-treat asthma who had been given acid-suppressing medication had alterations in the bacterial environment in their airways that reduced their responsiveness to corticosteroid medication for their asthma. This unresponsiveness can lead to persistent inflammation in their lungs and more severe asthma.