Uncontrolled asthma symptoms may start in the stomach

Uncontrolled gastroesophageal reflux can push stomach contents into lungs, causing irritation and asthma-like symptoms.

For most of the 25 million Americans living with asthma, symptoms are controlled with an inhaler or other medication. For some, however, breathing problems persist or worsen, even after trying several asthma treatments. For these patients, the problem may not be asthma at all, but gastroesophageal reflux disease, or GERD. Experts at National Jewish Health say it is common for GERD to mimic asthma or worsen symptoms of existing asthma because reflux is entering the airway, causing symptoms such as coughing, wheezing, shortness of breath and pneumonia.

"When patients come in with persistent asthma and medications aren't helping, it's time to start considering that the issue may be coming from somewhere outside of the lungs," said Jeffrey B. King, MD, chief of Gastroenterology at National Jewish Health. "It's not uncommon to find that these patients never had asthma, and that the true problem is starting in the stomach."

Reflux is a normal function, and it is only when stomach contents rise to the back of the throat and enter the airways and lungs that reflux begins to cause health problems. A dysfunction of the muscle where the stomach meets the esophagus is often to blame. When that muscle is not tight enough, stomach contents travel up the esophagus to the airway and enter the lungs.

"If left unchecked, this can cause permanent scarring in the lungs," said Dr. King. "Long-term, GERD can increase a patient's risk for esophageal cancer or cause such severe damage that they need a lung transplant."

But when a multidisciplinary approach is embraced, lung issues caused by GERD can be identified and effectively treated through lifestyle changes, medication or, in severe cases, surgery.

"We can actually go in and tighten that muscle at the base of the esophagus, or implant a band that makes that opening smaller and helps control reflux," said Dr. King.

That was the best treatment option for Michelle Skeldon, who suffered with worsening breathing issues for more than a decade before she received an accurate diagnosis of GERD at National Jewish Health.

"My doctors kept trying different inhalers and nothing worked," said Skeldon. "It got to the point where I couldn't climb a few stairs without being completely out of breath, and I was put on oxygen for two years."

After being admitted to the hospital with bacterial pneumonia, she was finally referred to a specialist who recognized the root of the problem. Her symptoms immediately began to improve after undergoing surgery.

"It was like night and day," said Skeldon. "After surgery my oxygen levels went up to where they needed to be, the coughing fits stopped, and I could finally breathe normally and live my life."

Dr. King says part of the reason GERD is often overlooked is because reflux is not always acidic, meaning it doesn't come with the heartburn and indigestion usually associated with reflux. Patients can have several of these harmful reflux events every day and not even feel them. It's only when they experience issues with their lungs that the problem is recognized.

"That's also why treating GERD with traditional acid reducers usually doesn't help," said King. "The problem is not that there is acid, but that the reflux is happening in the first place. Correcting that problem is what brings relief from symptoms, oftentimes after years of searching for answers.

Dr. King hopes more health care institutions will test for GERD when patients have unresolved breathing issues. He says early treatment is critical to minimizing damage and dangerous effects of untreated reflux.

National Jewish Health is the leading respiratory hospital in the nation. Founded 120 years ago as a nonprofit hospital, National Jewish Health today is the only facility in the world dedicated exclusively to groundbreaking medical research and treatment of patients with respiratory, cardiac, immune and related disorders. Patients and families come to National Jewish Health from around the world to receive cutting-edge, comprehensive, coordinated care. To learn more, visit the media resources page.