Heartburn and Asthma: What's The Link?

The connection between asthma and heartburn is a two-way street. If you have asthma, your chances of having heartburn go up. And if you have frequent heartburn, it can trigger asthma symptoms or make them worse.

Doctors aren't exactly sure why the conditions go together so closely, but they do know the link involves stomach acid and your airways.

How Heartburn Affects Asthma

You get heartburn when an opening between your stomach and your esophagus doesn't work the way it should. The esophagus is a tube that connects your stomach and your throat. The faulty opening lets acid in your stomach get into the esophagus. You may hear your doctor call this "acid reflux."

Your esophagus doesn't have the same protective lining as your stomach, so the acid irritates it and often causes an uncomfortable burning feeling in your chest. It's normal for it to happen now and then, but if it's a long-term problem it could be a sign of GERD (gastroesophageal reflux disease).

There are two ways acid reflux can trigger asthma or make symptoms worse:

Acid touches the nerves in your esophagus. This sets off a chain reaction. The nerves tell your brain to tell your airways to protect themselves from the acid. Your airways narrow to keep the acid out, and asthma symptoms start.

Stomach acid gets into your lungs directly. The acid irritates your airways, which makes you wheeze, cough, and feel tightness in your chest.

You can sometimes have GERD without typical heartburn symptoms. Your doctor can help figure out if "silent" GERD is affecting your asthma by asking you certain questions.

Often, GERD is the culprit behind your asthma if:

• Your asthma symptoms start when you're an adult.
• Your asthma gets worse after you eat, exercise, or lie down.
• Asthma treatments don't work very well for you.
• You cough or often have a hoarse voice.

If your doctor isn't sure you have GERD, they may do a few tests, including:

• Laryngoscopy
• Swallow test with X-ray
• Endoscopy. This looks at your esophagus with a small flexible tube with a light and camera on it.
• Ambulatory acid (pH) test. This keeps track of the amount of acid in your esophagus.
• Esophageal impedance test. It measures how things move through your esophagus.

How Asthma Affects Heartburn

Some asthma drugs may raise your chances of getting acid reflux because of the way they affect different muscles in your body. Prednisone and albuterol may affect the muscles that control the opening between your esophagus and your stomach. This may allow acid to leak into your esophagus.

Other asthma drugs have an impact on the muscles that make up the walls of your esophagus -- and keep it from working the way it should.

What to Do When You Have GERD and Asthma

If GERD makes asthma symptoms worse, and asthma medication makes GERD worse, how do you break the cycle? Often the answer is to focus on your GERD and get it under control. Once your acid reflux goes down, your asthma symptoms will likely get better.

Your doctor can help you decide whether you need medication for your GERD symptoms. They may suggest you start with over-the-counter medicines like:

• Antacids, which neutralize acid in your stomach
• H2 blockers, which keep your body from making as much acid
• Proton-pump inhibitors, which can reduce the amount of acid your body makes

Sometimes, though, you need prescription medication to get GERD symptoms under control. In rare cases, your doctor will suggest surgery for GERD. There are also things you can do at home to ease your GERD symptoms, like:

• Sleep with the head of your bed raised 6 to 8 inches so that gravity can help your stomach acid stay in your stomach.
• Don't eat for 3 to 4 hours before you lie down to sleep at night.
• Eat small meals throughout the day instead of three large meals.
• Lose extra weight that may put pressure on your belly.
• Stay away from fatty and acidic foods.
• Quit smoking.
• Wear loose clothes and avoid belts.

You can also take special care to avoid your asthma triggers while you manage your GERD symptoms to help stop the cycle.

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