eMedicineLive

Gastroesophageal reflux disease (GERD) is a common problem and 34 to 82% of people with asthma may have acid reflux disease. Several factors are considered to increase the risk of acid reflux in asthma including asthma related bronchoconstriction, decreased tone of lower esophageal sphincter due to asthma medications, altered pressure dynamics of abdomen and thorax and herniation of lower esophageal sphincter due to hyperinflation of lungs.

Acid reflux can exacerbate asthma as the acidic stomach contents can irritate the bronchial mucosa and trigger bronchoconstriction.  Hence treatment of acid reflux might be beneficial in preventing asthma exacerbations and reducing the symptoms. Current guidelines suggest that all persons with poorly controlled asthma especially with night time symptoms should be evaluated for GERD and prescribed antacids if GERD is found.  Indeed it is a common practise in case of poorly controlled asthma to prescribe proton pump inhibitors (a group of drug). Several smaller studies show that treatment of acid reflux in asthmatics with proton pump inhibitors have improved symptoms of asthma

But in a larger placebo controlled study published in NEJM, efficacy of proton pump inhibitors (esomeprazole) was assessed in poorly controlled asthma  patients with asymptomatic gastroesophageal reflux. The study was carried out for 24 weeks but no improvement in asthma control was achieved.  The authors suggest that asymptomatic GERD may not be the cause of poor asthma control and we need to look at other causes. Based on the study the authors claim that proton pump inhibitors should not be routinely prescribed for asthma symptoms if the patient does not have symptoms of GERD. Also it is not mandatory to evaluate for GERD in asymptomatic patients

Though further studies are needed as the results of the available studies are conflicting, from the available information we can presume that if GERD is symptomatic treatment of GERD improves asthma control while treatment of asymptomatic GERD doesn’t improve asthma control.

Reference
http://www.nejm.org/doi/full/10.1056/NEJMoa0806290