Treatment & Management
studied six patients with suspected nocturnal aspiration while they concomitantly monitored overnight intraesophageal pH. Three patients had prolonged episodes of acid GER and positive lung scans and three patients had prolonged episodes of decreased LES pressures, rapid clearing of the esophageal acid, and negative scans. The investigators suggested that good esophageal motility with rapid clearance was important in preventing pulmonary aspiration. Often esophageal GER symptoms are not present in patients with extraesophageal manifestations of GER. Patients may have heartburn, regurgitation, or worsening cough/bronchospasm associated with foods that lower the LES pressure.
He or she can diagnose your condition and provide a management plan and treatment for you. Have you experienced coughing, wheezing, or shortness of breath at night in the past month? Unexplained nighttime asthma symptoms may indicate that you have reflux as well. Because you are sleeping you may not be aware that your reflux is severe enough that you are actually aspirating food particles into your lungs and this may be what is causing your restlessness and asthma symptoms. which found that asthma patients with GERD showed no overall improvement in asthma after treatment of reflux.
and a score greater than 14.7 was considered positive for pathologic acid reflux. The catheter was attached to an ambulatory recording device, and the total testing period was 24 hours. Composition (liquid, gas, or mixed), proximity, and duration of reflux events were recorded.
What Is Eosinophilic Asthma?
Difficulty breathing is one of the more frightening symptoms of acid reflux and the chronic form of the condition, which is called gastroesophageal reflux disease (GERD). GERD can be associated with breathing difficulties such as bronchospasm and aspiration. These difficulties can sometimes lead to life-threatening respiratory complications.
There are currently no simple objective measures of airway reflux, although tests such as salivary pepsin in the form of the Peptest can be useful markers . The diagnosis of airway reflux is reliant on the clinical history. Questionnaires such as the Hull Airways Reflux Questionnaire (HARQ; available at www.issc.info) are used to score the characteristic clinical features of such reflux, such as postprandial coughing, a funny taste in the mouth or symptoms on phonation (fig. 2).
The EPR-3 guidelines provide the framework for assessing the patient, gathering diagnostic and disease monitoring information to establish the diagnosis and follow its course, treatment options and strategies, patient and family education, and it addresses comorbid conditions. Treatment is based on severity and includes medications (classified as rescue or control), education, self-management, strategies to prevent exposure to triggers, and reduce problems caused by comorbid conditions.
One possibility is that acid flow causes injury to the throat lining, airways, and lungs. This can bring about an asthma attack in those who have preexisting asthma. Another reason may be that when acid enters the esophagus, it triggers a nerve reflex that causes airways to constrict to keep acid out. This leads to shortness of breath.
The transient LES relaxations occur in patients with GERD most commonly after meals when the stomach is distended with food. Transient LES relaxations also occur in individuals without GERD, but they are infrequent. GERD is the back up of stomach acid into the esophagus. The first part of the small intestine attached to the stomach. Acid is believed to be the most injurious component of the refluxed liquid.
Being very overweight puts you at risk of more asthma symptoms, and you’re more likely to need your reliever inhaler more often. In older people, being obese may be a factor in why they got asthma in the first place.
Lung biopsy, oesophageal probe, direct airway visualisation, upper gastrointestinal endoscopy and nuclear scintigraphic studies are all potentially useful modalities, but all have significant limitations, and the diagnostic approach should be tailored to the individual patient. Treatment consists of acid suppression and lifestyle modifications; refractory cases should be considered for laparoscopic fundoplication, understanding that a significant percentage will nonetheless require long-term acid suppression therapy. et al.  reported 10-yr outcomes in patients randomised to surgical or medical management of GERD as part of the VA Cooperative study, showing that while 92% of medically managed patients continued to use anti-reflux medications, 62% in the surgery arm also required medical therapy. et al.  studied 16 patients with recurrent respiratory symptoms identified from a large group of patients having total gastrectomy. These patients had prominent nocturnal reflux symptoms with productive cough, often followed by morning fever, and many had been evaluated for fever of unknown origin.
The striking epidemiological association is consequently dismissed as two common diseases coexisting. In reality, it is the obsession with acid reflux and failure to appreciate that it is the non-acid component of gaseous reflux that is pathogenic, which is responsible for this confusion. Trials of promotility agents such as azithromycin, and of fundoplication are awaited with interest. Patients with asthma often have lung hyperinflation.
Representative impedance tracings of laryngopharyngeal reflux (LPR) and high esophageal reflux. Left, distal pH decreased to less than 4, and retrograde bolus transit reached the hypopharynx.
In addition to clinical suspicion, HRCT is important in suggesting these diagnoses. Evaluation strategies should focus on proving proximal reflux and pulmonary aspiration.