Dennis K. Ledford; Richard F. Lockey


Curr Opin Allergy Clin Immunol. 2013;13(1):78-86. 

In This Article

Gastroesophageal Reflux Disease

An increase of retrograde movement of gastric contents into the esophagus is termed GERD or if the refluxate reaches the larynx, laryngopharyngeal reflux. Gastroesophageal reflux is a normal physiologic phenomenon and is termed GERD only when the frequency and duration of acid refluxate exceed a defined parameter. The reflux events are generally quantified with a pH probe placed in the esophagus. The prevalence of GERD in the general adult population is 10–20% in western countries but approximately 5% in Asia. The prevalence of GERD in pediatric studies is 2–8%.

Atypical symptoms of GERD include throat tightness, throat clearing, cough, chest tightness, and hoarseness. Some individuals will describe a sensation of postnasal drip, suggesting upper airway disease as a source. The cough with laryngopharyngeal reflux will usually be described as originating in the larynx or pharynx rather than the chest, but this distinction is subject to patient perception and some will describe the cough as originating in the chest.

Relationship With Asthma

There is a confirmed relationship of GERD and asthma as well as GERD with upper airway complaints.[15,16] The nature of this relationship, specifically if there is causality between airway dysfunction and GERD, is less clear. Epidemiologic studies demonstrate a variable prevalence of GERD in individuals with asthma, ranging from 12 to 85%, with some of the variation due to the definition of GERD. Conversely, asthma is reported more commonly in individuals with GERD. There is also evidence of increased upper airway complaints in individuals with GERD.[16] Asthma therapies, particularly theophylline and albuterol, may decrease lower esophageal sphincter tone, suggesting asthma therapy may increase GERD.

Diagnostic or Therapeutic Considerations

GERD may pose diagnostic challenges in that cough, laryngeal or pharyngeal irritation, and chest tightness are common symptoms in individuals with asthma and/or GERD and/or upper airway disease. Thus, the symptoms of GERD may be misinterpreted as asthma or rhinitis both when making a diagnosis and when monitoring patients for control of their respiratory disease.

There is conflicting evidence that therapy of GERD improves asthma. Double-blind, prospective, controlled trials demonstrate that treatment of asymptomatic GERD does not improve asthma in adults or children.[17,18] Treatment of GERD in double-blind studies[19,20] of individuals with asthma and symptomatic GERD shows a benefit for asthma quality of life and number of exacerbations but inconsistent effects on asthma symptoms, albuterol use, and pulmonary function. Cochrane review of all controlled trials of GERD therapy in adults and children with asthma found a lack of benefit in achieving asthma control, although there is a suggestion of reduced albuterol use and clinical benefit in an undefined subset of affected individuals.[21] Finally, asthma or asthma therapy may aggravate or appear to aggravate GERD as bronchodilators may reduce esophageal sphincter tone, systemic corticosteroids may increase gastric acid production, and inhaled corticosteroids may cause hoarseness similar to the hoarseness caused by GERD.