The Asthma-Acid Reflux Connection

Asthma Asthma is a chronic disease in which the airways become inflamed and sensitive, causing them to react to certain triggers. During an asthma attack, the lining of the airways swells and produces extra mucus. The muscles surrounding the airways also tighten. These changes make it difficult to get air in to and out of the lungs. Patients may experience coughing, wheezing, chest tightness, shortness of breath or rapid breathing. In severe cases, the airways become so constricted, patients aren't able to get enough oxygen. Without prompt treatment, the patient can die.
According to the American Academy of Allergy, Asthma and Immunology, about 20 million Americans have asthma. Roughly 5,000 people die of asthma each year. There are many potential triggers for asthma, such as animal dander, pollen, cigarette smoke, cold air, certain smells and strong emotions.
Acid Reflux Acid reflux (gastroesophageal reflux, or GERD) is a condition that occurs when stomach acids flow backward into the esophagus. There is a ring of muscles between the lower end of the esophagus and the stomach, called the lower esophageal sphincter (LES). Normally, the LES acts like a one-way valve to allow food to pass from the esophagus into the stomach. In patients with acid reflux, the LES doesn't close properly, allowing contents of the stomach acids to leak backward into the esophagus.
The most common symptom of acid reflux is heartburn (a burning sensation in the chest or throat). The symptoms, often referred to as acid indigestion, can last for two hours. Heartburn is a common complaint. The American College of Gastroenterology estimates more than 60 million Americans experience the problem at least once a month. When symptoms occur more than twice a week, patients may have GERD. Over time, acid reflux can lead to a narrowing of the esophagus (esophageal stricture), bleeding, choking or a condition called Barrett's esophagus (a pre-cancerous condition in which the cells lining the esophagus are replaced with cells that normally line the stomach).
The Asthma-Reflux Connection Researchers say acid reflux affects 20 to 30 percent of Americans. But the condition occurs in as many as 70 percent of patients with asthma. The reason for the high incidence in asthmatics is not certain. However, there are several theories about the association. Pressure changes in the chest during an asthma attack may allow the LES to relax and stomach acids to back up into the esophagus. The acid may irritate the lungs and further aggravate asthma. Hiatal hernia and some asthma medications may contribute to relaxation of the LES.
Now a nationwide study aims to take a closer look at the connection between asthma and acid reflux. It's called the "Study of Acid Reflux in Asthma," or SARA. Researchers are enrolling 400 people with asthma who have poor control over their symptoms. Participants will be randomized into one or two groups. One group will receive 40 mg. of the medication, esomeprazole (NEXIUM®), twice a day. This drug is a proton pump inhibitor that is often used to treat patients with acid reflux. The second group will receive a placebo. Neither researchers nor patients will know who has received the active drug and who has received the placebo.
During the study, doctors will measure the presence and severity of acid reflux symptoms and compare the findings to asthma symptoms. The goal of the study is to determine if treatment of acid reflux helps to improve asthma symptoms. The study will be ongoing until August 2007. For information log onto the study site at http://www.clinicaltrials.gov/ct/gui/show/NCT00069823. Information is also available on the American Lung Association website at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=37101.
Study of Acid Reflux in Asthma, or SARA, sites: University of Alabama at Birmingham, Birmingham, AL University of California at San Diego, San Diego, CA National Jewish Center, Denver, CO Nemours Childrens Clinic, Jacksonville, FL University of Miami, Miami, FL Emory University, Atlanta, GA Northwestern Memorial Hospital, Chicago, IL Indiana University ACRC, Indianapolis, IN LSUHSC Pulmonary Critical Care, New Orleans, LA University of Minnesota, Minneapolis, MN University of Missouri Kansas City School of Medicine, Kansas City, MO Washington University School of Medicine, St. Louis, MO North Shore-LIJ Medical Center, New Hyde Park, NY NYU School of Medicine, New York, NY New York Medical College, Valhalla, NY Duke University, Durham, NC Ohio State University, Columbus, OH Thomas Jefferson Hospital Pulmonary Lab, Philadelphia, PA Baylor College of Medicine, Houston, TX Northern New England Consortium, Colchester, VT
For information about the study: http://www.clinicaltrials.gov/ct/gui/show/NCT00069823. Information is also available on the American Lung Association website at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=37101.