Gastroesophageal reflux disease and asthma: the two are directly related.

GERD and asthma have met the three criteria set out to prove a relationship between the two diseases. Patients with GERD have a higher prevalence of asthma, and there are several pathophysiologic mechanisms by which acid reflux can cause bronchospasm. Furthermore, aggressive antireflux therapy in patients with asthma and GERD results in improvements in asthma outcome in as many as 70% to 80% of patients treated in both medical and surgical series. Nevertheless, there are design flaws in many of the outcome studies performed to date. To further clarify this issue, future studies should be multicentered and placebo controlled using acid-suppressive therapy for at least 3 to 6 months with documentation of asthma outcome, cost analysis, and quality-of-life assessment. As with many things in medicine, all the data are not consistent. However, I strongly believe that the available data support the aggressive search for GERD and treatment in any patient with difficult-to-control asthma.