Gastroesophageal reflux disease and asthma. Diagnosis and management.

Gastroesophageal reflux is common among asthmatics. It not only may worsen during an episode of airways obstruction but also may serve as a trigger for such an attack. Both animal and clinical data suggest that gastroesophageal reflux serves as a trigger of bronchospasm, potentiates the bronchomotor response to additional triggers, or both. Patients with reflux-associated asthma may manifest symptoms of gastroesophageal reflux, either classic or atypical, but approximately 25% to 30% have clinically silent reflux. Despite the use of inadequate doses of acid-suppressive medicines, clinical trials have documented improvement in respiratory symptoms among asthmatics following the treatment of reflux. Recent trials suggest long-term improvement in respiratory symptoms following antireflux surgery. Selected patients with asthma should be evaluated for gastroesophageal reflux. If it is present, such patients may benefit from aggressive antireflux therapy.