Gastroesophageal reflux: a potential asthma trigger.
Gastroesophageal reflux (GER) is a potential trigger of asthma. Approximately 77% of asthmatics report heartburn. GER is a risk factor for asthma-related hospitalization and oral steroid burst use. Asthmatics may be predisposed to GER development because of a high prevalence of hiatal hernia and autonomic dysregulation and an increased pressure gradient between the abdominal cavity and the thorax, over-riding the lower esophageal sphincter pressure barrier. Asthma medications may potentiate GER. Potential mechanisms of esophageal acid-induced bronchoconstriction include a vagally mediated reflex, local axonal reflexes, heightened bronchial reactivity, and microaspiration, all resulting in neurogenic inflammation. Anti-reflux therapy improves asthma symptoms in approximately 70% of asthmatics with GER. A 3-month empiric trial of twice-daily proton pump inhibitor given 30 to 60 minutes before breakfast and dinner can identify asthmatics who have GER as a trigger of their asthma.
Harding
Susan M
SM
Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT Rm 215, Birmingham, AL 35294, USA. sharding@uab.edu
D001249:Asthma / Q000209:etiology* / Q000503:physiopathology*; D016084:Bronchoconstriction; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007249:Inflammation; D015995:Prevalence; D054328:Proton Pump Inhibitors; D012307:Risk Factors
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors