GERD Asthma Treatment

Once GERD is suspected or thought to be responsible for asthma symptoms, treatment may be with either prolonged PPI (proton pump inhibitor) therapy or anti reflux surgery. A 3- to 6-month trial of high-dose PPI therapy [twice a day (b.i.d.) or three times a day (t.i.d.) dosing] may help confirm (by virtue of symptom resolution) that GERD is partly or completely responsible for the asthma symptoms. The persistence of symptoms despite PPI treatment, however, does not necessarily rule out GERD as a potential contributor.
Based on reported observations, relief of asthma symptoms can be anticipated for 25% to 50% of patients with GERD asthma treated with anti reflux medications.
Fewer than 15%, however, can be expected to have objective improvements in their pulmonary function. The reason for this apparent paradox may be that most studies employed relatively short courses of anti reflux therapy (less than 3 months). This time period may have been sufficient for symptomatic improvement but insufficient for recovery of pulmonary function. The chances of success with medical treatment are likely directly related to the extent of GERD elimination. The conflicting findings of reports of anti reflux therapy may well be to the result of inadequate control of GERD in some studies. The literature indicates that anti reflux surgery improves asthma symptoms in nearly 90% of children and 70% of adults with asthma and GERD. Improvements in pulmonary function were demonstrated in around one third of patients. Comparison of the results of uncontrolled studies of each form of therapy and the evidence from the two randomized controlled trials of medical versus surgical therapy indicate that fundoplication is the most effective therapy for GERD asthma. The superiority of the surgical anti reflux barrier over medical therapy is probably most noticeable in the supine posture, which corresponds with the period of acid breakthrough with PPI therapy and is the time in the circadian cycle when asthma symptoms and peak expiratory flow rates are at their worst.
It is also important to realize that, in asthmatic patients with a non reflux induced motility abnormality of the esophageal body, performing an anti reflux operation may not prevent the aspiration of orally regurgitated, swallowed liquid or food. This can result in asthma symptoms and airway irritation that may elicit an asthmatic reaction. This factor may explain why surgical results appear to be better in children than adults, because disturbance of esophageal body motility is more likely in adult patients.