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Reflux Related Adult Onset Asthma

Reflux-related asthma is defined as symptoms of asthma (such as cough and wheezing) that manifest in members of the adult population who have no history of allergy, do not smoke, who present with respiratory symptoms that are worse after eating or during the night, and who may show improvement of their symptoms with antacid therapy.
Use this section to learn about:

  • Causes & Symptoms
  • Diagnosis
  • Treatment

The esophagus and trachea (windpipe) are in close relationship. GERD is common in patients with asthma and has been identified as a potential trigger for asthma, and patients with GERD may have asthma-like symptoms.

Asthma and Heartburn Relationship

There is a mutual cause-and-effect relationship between asthma and GERD. In some situations, reflux disease can actually cause the asthma, particularly adult-onset asthma. In other cases the GERD can potentiate existing asthma, making it difficult to control. In addition, asthma symptoms such as cough and wheezing magnify the difference in pressure between chest (negative pressure) and abdomen (positive pressure), encouraging GERD.


GERD can cause asthma-like symptoms via two mechanisms:

  • Aspiration of acid particles in the trachea can cause coughing, wheezing and pneumonia
  • Acid in the esophagus causes a reflex phenomenon in the trachea, triggering asthma-like symptoms

Thus, it is important for physicians to consider the possibility of GERD when treating patients with lung problems.


Patient may have the common symptoms of reflux, including heartburn, difficulty swallowing and regurgitation.

However, as a result of the close relationship between the esophagus and windpipe, many patients may present with uncommon breathing symptoms including:

  • Chronic cough
  • Hoarseness (voice change)
  • Wheezing
  • Pneumonia
  • Aspiration

Chronic aspiration of gastric acid and bile (non-acidic fluid), which typically occurs at night when patients are lying down, can severely damage the lungs and vocal cords. Long-standing aspiration can even cause severe pulmonary disease such as pulmonary fibrosis.


The following resources provide a comprehensive look at diagnosis for reflux related adult onset asthma.

  • Videoesophagram
  • Esophageal motility study
  • Esophageal pH assessment
    • 24-hour pH study. In patients with respiratory symptoms, additional measurement in the upper part of the esophagus is made to identify how much acid refluxes up into the mouth, pharynx and possibly into the windpipe, causing respiratory symptoms and damage to the lungs.
    • 48-Hour Esophageal pH testing with the Bravo capsule wireless system
  • Pharyngeal pH assessment In patients with respiratory symptoms, additional measurement in the pharynx is made to identify how much acid refluxes up into the mouth, pharynx and possibly into the windpipe, causing respiratory symptoms and damage to the lungs.
  • Upper endoscopy


To treat adult-onset asthma, many patients succeed in relieving most if not all the systems of GERD through dietary changes and lifestyle changes. Medications help others who need help controlling their reflux symptoms.

Surgical treatment, most commonly Nissen fundoplication, is recommended for patients that develop progressive diseases, or experience other more severe symptoms.

By Farzaneh Banki, M.D.


1. Sontag SJ, Schnell TG, Miller TQ. Prevalence of esophagitis in asthmatics. Gut 1992; 33: 872-876.
2. Field SK, Sutherland LR. Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux?: a critical review of the literature. Chest 1998; 114: 275-283.
3. John G. Hunter, M.D., Ted L. Trus, M.D., Gene D. Branum, M.D., J. Patrick Waring, M.D., and William C. Wood, M.D. A Physiologic Approach to Laparoscopic Fundoplication for Gastroesophageal Reflux Disease. Annals of Surgery 1999, Vol. 223, No. 6, 673-687
4. David J. Bowrey, FRCS(Engl), Jeffrey H. Peters, MD, and Tom R. DeMeester, MD. Gastroesophageal Reflux Disease in Asthma Effects of Medical and Surgical Antireflux Therapy on Asthma Control Ann Surg. 2000 February; 231(2): 161–172