by Dr Deborah Lee, Dr Fox Online Pharmacy
https://pixabay.com/illustrations/stomachache-acid-reflux-gastritis-6509430/
Gastro-oesophageal reflux disease (GERD) is very common and is said to affect up to one-third of adults, on at least one occasion per month. But did you know that acid reflux can affect your breathing?
- What is the link, and why does this happen?
- What are the take-home messages?
Read on and find out.
What is GERD?
GERD is thought to occur because the lower oesophageal sphincter – the ring of muscle at the lower end of the oesophagus, as the top of the stomach – becomes incompetent. It can no longer prevent acidic stomach contents from tracking back up into the oesophagus.
Acid is highly irritant to the oesophageal epithelium (lining). When this happens, it causes an array of different symptoms including heartburn, chest pain, acid brash in the throat, feeling nauseous, and belching.
How does acid reflux make it harder to breathe?
Recent research has demonstrated a link between GERD and lung disease. The exact mechanisms are unclear, but it seems that acid may be able to find its way into the lungs. It may even be because the lungs constrict as part of a reflex action to try and prevent the acid from getting into the airways. Whatever the reason, lung disease is more common in those with GERD, and GERD can make existing lung conditions worse.
The following lung conditions are linked to GERD –
- Asthma – 30-80% of patients with asthma have GERD
- Chronic cough – 10-40% of patients with GERD have a chronic cough
- Chronic bronchitis
- Aspiration pneumonia, lung abscess, and bronchiectasis
- Idiopathic pulmonary fibrosis
Asthma and GERD
Asthma is a common respiratory condition caused by a narrowing of the airways (bronchospasm) – the bronchi. An acute attack of asthma causes symptoms of cough, wheeze, breathlessness, and chest tightness. Acute episodes of asthma are set off by triggers – such as allergies to house dust, pollen, animal dander, or the noxious effects of cigarette smoke, or pollution. However, GERD is an often unrecognised trigger for asthma.
GERD is believed to worsen asthma for the following reasons –
- The bronchi become hyper-reactive to other triggers, due to acid stimulation of the vagus nerve.
- Over-sensitive airways become easily irritated by the inhalation of even minute quantities of acid.
- The airways respond by exerting defensive mechanisms such as cough, bronchospasm, and the production of excess respiratory mucus.
- During attacks of acute asthma, studies have demonstrated a lower tracheal pH, which is also present in the oesophagus during an episode of GERD.
It’s common for a patient to present to their GP with respiratory symptoms – which are in fact due to GERD – but with no symptoms of heartburn.
What to do about breathing difficulties and acid reflux
In the longer term, attacks of asthma will be less likely if there is good control of GERD symptoms. One systematic review showed that treating GERD improved asthma symptoms in 69% of patients and reduced the use of asthma medication by 62%. In another study, the use of proton pump inhibitors (PPIs) for 3 months, reduced asthma symptoms by 73%.
In the acute situation, when GERD symptoms have flared, breathing may become a problem. It’s important not to panic and to try and stay calm. Stay upright and don’t lie down. Don’t smoke.
- Take some antacids, such as Gaviscon tablets or liquid.
- Learn how to do diaphragmatic breathing. To do this, sit or stand upright, and try to relax. Breathe out as far as you can. Then breathe in through your nose slowly, by sucking in your abdomen. This will cause your chest to inflate. Then slowly breathe out, keeping your lips pursed. Then start again, and repeat. Keep doing this over and over again.
- Take 1 puff of your reliever (blue) inhaler. If this does not give relief, you can take up to 10 puffs at 60-90 second intervals if you need to. If you don’t feel any better, you must ring 999 for an ambulance.
Final thoughts
Both GERD and asthma are serious medical conditions, and each can exacerbate the other. However, there are good treatment options for both.
If you think you might have GERD, especially if it makes you feel breathless, or you are experiencing any chest symptoms, you are strongly advised to see your GP.
- NHS – Asthma