The relationship between asthma and reflux goes beyond what you imagine

MADRID, 2 May. (EDITIONS) -

Asthma and reflux are more connected than we think. They tend to occur at the same time in many patients, and asthma can make reflux worse, and vice versa. In this article, we chat with several experts in the field who tell us why this may be the case.

"Asthma and gastroesophageal reflux disease, or GERD, have a two-way relationship. People with asthma are more likely to develop GERD throughout their lives. Research has shown that 25 to 80 percent of adults with asthma they also have GERD", clarifies in an interview with Infosalus Dr. Ana Encabo, head of the Pneumology Section of the Severo Ochoa University Hospital.

But let's go step by step. First of all, the specialist at this hospital located in Leganés (Madrid) recalls that asthma is a respiratory disease, characterized by chronic inflammation of the airways, and that it can cause symptoms such as recurrent episodes of shortness of breath, wheezing in the chest with breathing, or coughing and a feeling of tightness in the chest.

"Bronchial asthma is characterized by reversible airway obstruction that, if not adequately treated, can lead to permanent obstruction. It is frequently associated with other pathologies and is usually triggered by a combination of environmental and hereditary factors," he indicates. .

Meanwhile, Dr. José Luis Castro Urda, head of the Digestive System at the same center, points out that the reflux of stomach acid into the esophagus is a physiological and normal event that occurs during our lives. "GERD occurs when this fact frequently produces symptoms, or esophageal structural alterations such as erosions or ulcers," he adds.

Thus, Dr. Encabo points out that GERD-related asthma usually begins in adulthood, and its symptoms usually worsen after a large meal, or occur during the consumption of alcoholic beverages, at night or in the supine position. (face up). "In this type of association, the usual asthma medications may become less and less effective," she cautions.

Here, the gastroenterologist warns that GERD-related asthma does not have to present the typical symptoms of this second disease such as heartburn (burning in the chest) and regurgitation.

Meanwhile, regarding the possible causes of the collusion of both pathologies, Dr. Encabo points out that when a patient suffers from GERD, the repeated flow of stomach acid into the esophagus can damage the epithelium of the respiratory tract and can make the lungs more sensitive to certain irritants, such as dust and pollen, which are known to trigger asthma.

"In this way, GERD can trigger asthma and worsen its symptoms. On the other hand, asthma can exacerbate and trigger the symptoms of acid reflux. Precisely, it has been seen that during an asthma attack the pressure in the chest and in the abdomen. This increase in pressure determines a compression of the stomach and can cause the muscles that usually prevent acid reflux to relax. This allows stomach acid to flow up the esophagus and into the airways," the doctor explains. .

The specialist in the digestive system, Dr. Castro Urda, underlines at this point that GERD usually occurs facilitated by a drop in the normal pressure of the lower esophageal sphincter, which should act as a valve that prevents excess acid reflux from the stomach into the esophagus: "We see this in hiatus hernia where part of the stomach is included in the thorax or in cardiac incompetence. There are factors that favor GERD, such as situations of abdominal hyperpressure, obesity, or pregnancy for example, but also tobacco, alcohol and coffee, as well as fats, chocolates, spicy foods, citrus fruits and certain drugs".

In cases where both pathologies go hand in hand, Dr. Encabo, who is a pulmonologist, sees it as necessary for the patient to correctly comply with their inhaled asthma treatment in the first place. She says that, next, it will be the specialist in the Digestive System who will have to assess the necessary tests to characterize the GERD.

In this sense, Dr. Castro Urda maintains that in the study of GERD an endoscopic study with gastroscopy is carried out to rule out anatomical alterations such as hiatal hernia or complications such as esophagitis, peptic strictures or Barrett's esophagus.

"To demonstrate excess acid in the esophagus, a 24-hour pH test is usually performed, which consists of a catheter housed in the distal esophagus, and which measures during a normal day of our lives. If antireflux surgery is considered, we must perform a previous esophageal manometry that studies the motor behavior of the body and the esophageal sphincters," he adds.

Ultimately, Dr. Encabo points out that in these cases it is essential to make a change in the patient's lifestyle and, for example, advises losing excess weight, as well as quitting smoking, avoiding foods or drinks that contribute to reflux acid (alcoholic or caffeinated drinks, chocolate, citrus fruits, fried foods, spicy foods, high-fat foods), eat smaller meals more often, eat meals at least 3 to 4 hours before bedtime, raise the head of the head the bed, apart from wearing loose clothes and belts.