the reflux / asthma connection

RMacLean
January 2005

When a child has asthma, the possibility of the child also having reflux should be investigated.  It's been estimated that the prevalence of reflux among asthma suffers range from 30 percent to 90 percent.  Most kids will have typical symptoms of reflux (spitting up or vomiting, excessive crying and irritability, etc) but some do not express any outward symptoms.  They are referred to as having silent reflux. Their only symptom may then become asthma and many doctors may not realize the link between reflux and asthma so the reflux never gets diagnosed or treated.  The child's asthma can then be difficult to control with the normal medications.

How does reflux make asthma worse?

One possible reason is the acid that comes up the esophagus can enter the airways, especially when lying down.  This acidic refluxate can cause the airways to narrow and create the wheezing and shortness of breath associated with asthma.  Over time, this refluxate can also damage the airways worsening asthma symptoms.  Another possibility is acid reaching the lower part of the esophagus can stimulate nerve endings causing the muscle in the airways to contract, narrowing breathing tubes.  This can be perceived as a shortness of breath.

How do i know if the asthma is reflux-induced?

Some indications that asthma could be caused by reflux are:

• The asthma symptoms get worse after eating, particularly high fat foods
• Asthma like symptoms appearing with any other typical or atypical symptoms of reflux
• Persistent cough, especially worse when lying down

It's important to remember that not all reflux will present typical symptoms.  In some cases the only symptom could be the presence of asthma.

how is reflux induced asthma treated?

Treating reflux induced asthma may be as simple as treating the reflux itself.  All the usual treatment methods apply to this type of reflux and as previously stated, the asthma can usually be controlled by treating the reflux.  Of course, because everyone is different, it's not always that simple for all kids and some could have stubborn cases that don't respond well to treatment.

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine