Patients with asthma who do not respond to therapy should be evaluated for gastroesophageal reflux disease (GERD), obesity, sleep apnea, etc. There are reports of treatment of asthma with symptomatic GERD which responded to proton-pump inhibitors.

The problem is that only 5% of reflux events are symptomatic. Because of this, the researchers suggest that all poorly controlled asthma patients should be evaluated for acid reflux even though they don’t have symptoms of acid reflux. The pharmaceutical treatment for acid reflux is esomeprazole.

A group of patients were followed on esomeprazole with esophageal pH monitoring of expired air. Forty percent of patients had pH levels low enough to be consistent with acid reflux. Distal pH of less than 4 is diagnostic of GERD. People who did not have symptoms of gastric reflux and poorly controlled asthma did not respond to proton pump inhibitors, however.

The author noted that the failure of response of the asthma to proton pump inhibitors does not mean that GERD is not related to the asthma. This could be partly related to the failure of 25% of patients with GERD to get results from proton pump inhibitors. There can be problems with patients missing their doses of medications and not responding as a result.

CONCLUSION: The authors found that patients with uncontrolled asthma who do not have symptoms of gastroesophageal reflux disease (GERD) do not respond well to protein pump inhibitors. This is true even in patients with exhaled air with pH low enough to be consistent with GERD.

NOTE: According to summary #295, GERD symptoms can be relieved with a combination of certain vitamin B’s, betaine, melatonin and the amino acids, tryptophan and methionine.

Read about the role of arginase and arginine in asthma.

To read the author’s abstract of the article click on the link to the author’s title of the article above.

PMID: 19357411.

Summary #307.