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Medical Forum / Diseases and Disorders / Asthma / May 2006Asthma patients
Could treating acid reflux actually help control asthma? Doctors know that not every asthma patient gets acid reflux, so they don't expect it to help everyone. But they hope it will help some. It will answer the question of who you should treat if it works, and almost equally important, who you shouldn't treat or who you shouldn't falsely give this medicine to thinking it's going to affect their asthma. Getting the proper medications and educating patients about asthma can save lives. Every year, about five thousand people die from asthma. Experts say most of those deaths are preventable. Check out the video about this study: http://www.groundhog.tv/apps/editor/staticplayer.jsp?clip=1147464200420.wmv"><img src=" > Could treating acid reflux actually help control asthma? Right now it looks like probably not - but it still may be worth a shot and the refulx itself is probabnly a good reason for treatment even without the asthma. > Doctors know > that not every asthma patient gets acid reflux, No, but more than would be randomly expected do. > so they don't expect it > to help everyone. Actually, they did expect that treating it would help. recent research has cast doubt on that. > Check out the video about > this study: And then look at my video about a bridge for sale.  Signature00doc >> Could treating acid reflux actually help control asthma? > > Right now it looks like probably not - but it still may be worth a shot and > the refulx itself is probabnly a good reason for treatment even without the > asthma. The connection between acid reflux and asthma is well known. There are numerous causes of asthma and acid reflux is a rather common cause. > Actually, they did expect that treating it would help. recent research has > cast doubt on that. What research? If acid reflux is the primary cause of asthma in a patient then controlling it will help considerably. >>> Could treating acid reflux actually help control asthma? >> [quoted text clipped - 3 lines] > >The connection between acid reflux and asthma is well known. Connection does not mean acid reflux causes asthma. Sneezing is connected with the common cold and yet no one suggests that sneezing cause the cold. They are associated with each other in a noncausal fashion. > There are >numerous causes of asthma and acid reflux is a rather common cause. Common "cause"? Please provide the evidence that acid reflux *causes* asthma. Remember that correlation does not imply causation. >> Actually, they did expect that treating it would help. recent research has >> cast doubt on that. > >What research? If acid reflux is the primary cause of asthma in a >patient then controlling it will help considerably. The operative word is "if". Where is the evidence of this causality. RC > Connection does not mean acid reflux causes asthma. Sneezing is > connected with the common cold and yet no one suggests that sneezing > cause the cold. They are associated with each other in a noncausal > fashion. So it is your belief that acid reflux plays no role in causing asthma? I beg to differ. Why? From my own experience. I have GERD. When it acts up for an extended time my asthma gets extremely serious. In such asthma attacks treating the acid reflux is the only thing that is ever effective with me. Like many people there is often multiple contributing factors that trigger their asthma. GERD is one of them. >Remember that correlation does not imply causation. What are you saying? Asthma causes GERD rather than the other way around? In people who's asthma is triggered or aggravated by GERD are you saying treating them for GERD will have zero effect on their asthma? > The operative word is "if". Where is the evidence of this causality. Studies have been done for many years. ACG's studies show very positive results in treating GERD to reduce asthma in patients that suffer from both. Heres another group who firmly believe in acid reflux induced asthma. http://www.infantrefluxdisease.com/reflux_asthma.php I could list 100's of websites but I also realize that Dr's never ever agree on anything. 20 years ago Dr's said positively that asthma could not be cause by GERD. Today I see quite the opposite. Much of what I have seen is my own experience and in talking with my specialists as well as numerous other patients. >> Connection does not mean acid reflux causes asthma. Sneezing is >> connected with the common cold and yet no one suggests that sneezing >> cause the cold. They are associated with each other in a noncausal >> fashion. > >So it is your belief that acid reflux plays no role in causing asthma? No. It is my belief that a causal connection has not been objectively demonstrated. >I beg to differ. Why? From my own experience. Anecdotes are a dime a dozen. > I have GERD. When it >acts up for an extended time my asthma gets extremely serious. So it may be that GERD exacerbates your asthma. That does not mean that it caused it. > In such >asthma attacks treating the acid reflux is the only thing that is ever >effective with me. So you control your asthma completely with treatment of your acid reflux? You don't use steroid inhalers or bronchodilator to treat it? > Like many people there is often multiple >contributing factors that trigger their asthma. GERD is one of them. As I said, there is a difference between something that exacerbates asthma and something that causes it. >>Remember that correlation does not imply causation. > >What are you saying? Asthma causes GERD rather than the other way >around? No. I don't know the exact relationship between asthma and GERD in you or anyone else. All I am saying is that because there my be a correlation between the two illnesses does not indicate causality. > In people who's asthma is triggered or aggravated by GERD are >you saying treating them for GERD will have zero effect on their asthma? I never said that. >> The operative word is "if". Where is the evidence of this causality. > >Studies have been done for many years. ACG's studies show very positive >results in treating GERD to reduce asthma in patients that suffer from both. Citations please. >Heres another group who firmly believe in acid reflux induced asthma. >http://www.infantrefluxdisease.com/reflux_asthma.php There are many people who believe many things. This does not make it so. Your link just gives someone's opinion but there are no citations in peer reviewed literature. I remain open minded but await further studies. >I could list 100's of websites but I also realize that Dr's never ever >agree on anything. 20 years ago Dr's said positively that asthma could >not be cause by GERD. Today I see quite the opposite. Much of what I >have seen is my own experience and in talking with my specialists as >well as numerous other patients. Maybe it is. But I have not seen the objective evidence of it. Anecdotes are not proof of anything. RC > So it may be that GERD exacerbates your asthma. That does not mean > that it caused it. Well heck, dust exacerbates my asthma, so does pollens, exercise and a host of other items. Do any of them 'cause' my asthma? What causes asthma is an unknown. So GERD is no different that everything else that exacerbates asthma. > So you control your asthma completely with treatment of your acid > reflux? You don't use steroid inhalers or bronchodilator to treat it? Steroids have zero effect with me. Short term drugs like Albuterol provide minimal relief. Long term drugs provide zero benefit for me. My asthma for the most part is not controlled. However, the most benefit I can get is with controlling acid reflux. Since doing so my days in the ER have drastically diminished and my overall strength and quality of life have gone up. > As I said, there is a difference between something that exacerbates > asthma and something that causes it. But you seem to put acid reflux in a different category than anything else that contributes to asthma. Nobody knows what causes asthma. Acid reflux is on the same list as allergies, exercise induced etc. > Maybe it is. But I have not seen the objective evidence of it. > Anecdotes are not proof of anything. What objective evidence is there to show what causes asthma? Nobody knows exactly. GERD is in the same place as anything else with regards to asthma. Miles, a pharmacist I know had surgical treatment for GERD at Mayo Clinic a few years ago, and was pleasantly surprised to find that his asthma greatly improved as a result of it. He went from needing medication and inhalers on daily basis to needing an emergency inhaler once in a while. His problem wasn't as severe as yours. If you find steroids don't do much and you've tried a lot of different combinations of medication, it's possible that bacteria has made your asthma worse. We sometimes post stating that asthma can be caused by bacteria, forgetting that it can also make asthma unmanageable. If you get sick a lot and find that your illnesses result in chest infections, it might be that GERD and a bacterial infection are both ganging up on you. Slightly off the wall, but at www.asthmastory.com, there's a post by a guy who took Dr. Hahn's protocol for infectious asthma (meaning bacteria related) and found his acid reflux had disappeared. You and Doc are right, there's definitely a connection that the experts have been writing about for years. > Miles, a pharmacist I know had surgical treatment for GERD at > Mayo Clinic a few years ago, and was pleasantly surprised to find [quoted text clipped - 18 lines] > You and Doc are right, there's definitely a connection that the > experts have been writing about for years. Thats an interesting concept that I plan to talk to my Dr. about next time I see him. My guess is that he's never heard of that mainly because it is not discussed in the asthma medical update reports that are published quarterly. I get those reports to read as well. I noticed talk about a blood test for such bacteria. Is that test pretty much conclusive? Is there more than just 1 bacteria to test for? I do get colds very easy and have trouble fighting them off. The last bout has stayed with me for almost 2 months. Dr. thinks I must have gotten some sort of chest infection and put me on Biaxin. That stuff always helps me quickly. > Thats an interesting concept that I plan to talk to my Dr. > about next time I see him. My guess is that he's never heard [quoted text clipped - 10 lines] > thinks I must have gotten some sort of chest infection and put > me on Biaxin. That stuff always helps me quickly. No tests are conclusive, in fact, if you go to the www.asthmastory.com website, on the bottom left of the home page you'll see a document from Dr. Hahn to other doctors, and in it he states he doesn't recommend testing. He also gives his protocol. You might want to print that out and show it to your doctor. > No tests are conclusive, in fact, if you go to the > www.asthmastory.com website, on the bottom left of the home page > you'll see a document from Dr. Hahn to other doctors, and in it > he states he doesn't recommend testing. He also gives his > protocol. You might want to print that out and show it to your > doctor. I'm not sure exactly which article you are referring to. >wrote: >> I'm not sure exactly which article you are referring to. Go to www.asthmastory.com. Look on the bottom left side of the home page for a document titled 'Asthma and Infection'. >> So it may be that GERD exacerbates your asthma. That does not mean >> that it caused it. > >Well heck, dust exacerbates my asthma, so does pollens, exercise and a >host of other items. Do any of them 'cause' my asthma? No, none of them cause your asthma. They all may cause your asthma to get worse. > What causes >asthma is an unknown. Exactly. > So GERD is no different that everything else that >exacerbates asthma. Bingo. >> So you control your asthma completely with treatment of your acid >> reflux? You don't use steroid inhalers or bronchodilator to treat it? [quoted text clipped - 5 lines] >days in the ER have drastically diminished and my overall strength and >quality of life have gone up. So even when you control your acid reflux you still have asthma symptoms. This means that the acid reflux may just be a contributing factor in worsening your asthma. And it may not be the acid reflux per se that is making the asthma worse. There may be psychologic factors associated with the acid reflux that is causing the problem. >> As I said, there is a difference between something that exacerbates >> asthma and something that causes it. > >But you seem to put acid reflux in a different category than anything >else that contributes to asthma. I do? If someone said dust causes asthma I would disagree with that statement too. > Nobody knows what causes asthma. Acid >reflux is on the same list as allergies, exercise induced etc. Yep. All things that make asthma worse in some people. >> Maybe it is. But I have not seen the objective evidence of it. >> Anecdotes are not proof of anything. > >What objective evidence is there to show what causes asthma? Nobody >knows exactly. GERD is in the same place as anything else with regards >to asthma. We agree. I disagreed with your use of the term "cause" to describe the relationship between GERD and asthma. YOu seemed to be suggesting that if you got rid of the acid reflux that your asthma would be cured instead of just being better controlled. RC > So even when you control your acid reflux you still have asthma > symptoms. This means that the acid reflux may just be a contributing > factor in worsening your asthma. About 20 years ago I had a very serious stomach infection that lasted 2 months. It caused massive amounts of acid reflux. That is the time my asthma went from controlled to uncontrollable. During that time Dr.s felt there was no connection to my stomach problems and asthma. It is my belief acid came up and caused scaring of the brochial tubes. My Dr. feels if that happened it may increase sensitivity to allergens and other issues that exacerbate my asthma. The damage per my Dr. would be for the most part permanent and not likely to improve much over the years. So all I can do is attempt to control those things that trigger attacks. > And it may not be the acid reflux per > se that is making the asthma worse. There may be psychologic factors > associated with the acid reflux that is causing the problem. I doubt that. I firmly believe acid reflux is a major contributing factor for asthma. You may have to experience such issues for an extended period of time to understand. >> So even when you control your acid reflux you still have asthma >> symptoms. This means that the acid reflux may just be a contributing [quoted text clipped - 5 lines] >felt there was no connection to my stomach problems and asthma. It is >my belief acid came up and caused scaring of the brochial tubes. Anatomy is not your strong suit is it? How the hell could acid reflux scar your bronchial tubes? What did you do, aspirate your stomach contents as this is the *only* way to scar your bronchii from stomach acid? And if you did aspirate your stomach contents to cause scarring of your bronchii you would have likely experienced a chemical pneumonitis and pulmonary fibrosis making asthma the least of your problems. And if that is the case then it is the direct result of the acid being *aspirated* that is causing the problem and not acid reflux per se. > My Dr. >feels if that happened it may increase sensitivity to allergens and >other issues that exacerbate my asthma. The damage per my Dr. would be >for the most part permanent and not likely to improve much over the >years. So all I can do is attempt to control those things that trigger >attacks. Actually my hypothesis (assuming you did not aspirate and you made not mention of that in your post) is that you happened to have a bad flare up of your asthma at the exact same time you had bad acid reflux. You may have psychologically connected the two such that when you had a flare up of acid reflux you would experience hypersensitivity in your airway from the stress associated with worrying about having an asthma attack. Now my hypothesis is pure speculation but think it may offer an explanation for why you keep having worsening asthma when your acid reflux acts up when there is no direct physical connection. >> And it may not be the acid reflux per >> se that is making the asthma worse. There may be psychologic factors >> associated with the acid reflux that is causing the problem. > >I doubt that. See above for possible explanation of how psychologic factors may have played a role in your pathophysiologic reaction. > I firmly believe acid reflux is a major contributing >factor for asthma. You may have to experience such issues for an >extended period of time to understand. I have no doubt you believe this. I am simply saying that I am skeptical and have offered an alternative explanation to yours. RC > Anatomy is not your strong suit is it? How the hell could acid reflux > scar your bronchial tubes? What did you do, aspirate your stomach > contents as this is the *only* way to scar your bronchii from stomach > acid? When acid is refluxed into the throat, it can get into the lungs and cause an aspiration pneumonia or asthma symptoms. Chronic acid reflux into the lungs may eventually produce permanent lung damage, called pulmonary fibrosis or bronchiectasis. Please try to control your argumentative nature. My knowledge of anatomy is not at issue. GERD can and does cause acid to get into the lungs. Do some reading on the subject as to how and why and then come back. Otherwise this type of discussion helps noone. > I have no doubt you believe this. I am simply saying that I am > skeptical and have offered an alternative explanation to yours. My Dr's feel strongly otherwise. So does my experience. Your belief it is psychological in nature is in my view without merit. My asthma started as a direct result of serious stomach issues. It is not psychological. >> Anatomy is not your strong suit is it? How the hell could acid reflux >> scar your bronchial tubes? What did you do, aspirate your stomach [quoted text clipped - 3 lines] >When acid is refluxed into the throat, it can get into the lungs and >cause an aspiration pneumonia or asthma symptoms. AGain how the hell can acid refluxed into your throat get into your lungs without aspirating it? And if you did aspirate stomach acid to causing scarring (your words, not mine) of the bronchial tubes you would have had a very serious problem with chemical pneumonitis and/or pulmonary fibrosis. Were you diagnosed with either of these maladies? > Chronic acid reflux >into the lungs may eventually produce permanent lung damage, called >pulmonary fibrosis or bronchiectasis. This is true if you aspirate the acid. But aspiration is pretty uncommon. Did you aspirate? Just having reflux is not enough to cause lung damage. >Please try to control your argumentative nature. My knowledge of >anatomy is not at issue. Sorry but your knowledge of anatomy is certainly an issue. You cannot get lung damage from acid reflux unless you aspirate. > GERD can and does cause acid to get into the >lungs. See above. > Do some reading on the subject as to how and why and then come >back. Otherwise this type of discussion helps noone. I have done reading on the subject. Why don't you provide me with a link that shows that GERD causes acid to get into the lungs. I have done a search and other than aspiration this does not happen. So I ask you again did you ever aspirate your stomach contents into your lungs causing pneumonitis? >> I have no doubt you believe this. I am simply saying that I am >> skeptical and have offered an alternative explanation to yours. > >My Dr's feel strongly otherwise. Your doctors think that acid reflux caused scarring of your lungs? Are these MDs we are talking about? You might want to get a second opinion. > Your belief it >is psychological in nature is in my view without merit. It is not my belief. I offered it as a possible explanation, nothing more. > My asthma >started as a direct result of serious stomach issues. It is not >psychological. It is your opinion that there is a causal relationship between your GERD and your asthma. I admit that there is a temporal relationship between the two. You are making a common logical fallacy called post hoc, ergo propter hoc. RC > AGain how the hell can acid refluxed into your throat get into your > lungs without aspirating it? Sigh. You seem to think this is something unusual. Do some reading. > And if you did aspirate stomach acid to > causing scarring (your words, not mine) of the bronchial tubes you > would have had a very serious problem with chemical pneumonitis and/or > pulmonary fibrosis. Were you diagnosed with either of these maladies? Your assumption is only partly correct. Yes it CAN cause such issues. Saying it WOULD cause such issues in all cases is incorrect. > This is true if you aspirate the acid. But aspiration is pretty > uncommon. Here you continue your completely naive knowledge of GERD and how and why it triggers asthma through bronchial tube irritation. > Sorry but your knowledge of anatomy is certainly an issue. Your knowledge of GERD and effects on asthma are whats at issue. Acid comes up to the throat and down into the lungs. Often while sleeping. Please educate yourself on GERD before mouthing off about it being psychological, uncommon or some other complete BS that helps nobody. >Your knowledge of GERD and effects on asthma are whats at issue. Acid >comes up to the throat and down into the lungs. Often while sleeping. >Please educate yourself on GERD before mouthing off about it being >psychological, uncommon or some other complete BS that helps nobody. Please cite reference to support this assertion. If you are unable to provide a reference then I shall assume it is just your opinion. Others can decide how educated your opinion is. RC > Please cite reference to support this assertion. If you are unable to > provide a reference then I shall assume it is just your opinion. > Others can decide how educated your opinion is. Oh geez, I have to educate you or you decare yourself a winner of nothing. You appear here to argue and seem to have no desire to educate yourself, otherwise you would have. I already did post a URL with one such reference. Do a quick google on GERD or Acid Reflux and Asthma. Learn! Ya, the relationship of GERD and Asthma is purely psychological. Geez, are you reading 25 year old medical journals? >Ya, the relationship of GERD and Asthma is purely psychological. > Geez, are you reading 25 year old medical journals? I never said that. I proposed a possible explanation for your symptoms. I did not imply or suggest that the relationship between GERD and asthma is *purely* psychological. I even admitted that I did not know if there was a causal relationship. I only said that I have not seen such a relationship objectively supported by the peer reviewed literature. I will ask one more time. Please post the best objective evidence that GERD results in aspiration of stomach acids while sleeping that causes asthma. If you still cannot provide evidence in peer reviewed journals of what you are saying this will be my last post. Maybe one of more doctors in this group can be of help. It is pretty pointless to try to discuss this topic with individuals who can only make straw man arguments and not provide any peer reviewed journal to support their POV. RC > When acid is refluxed into the throat, it can get into the > lungs and cause an aspiration pneumonia or asthma symptoms. > Chronic acid reflux into the lungs may eventually produce > permanent lung damage, called pulmonary fibrosis or > bronchiectasis. Miles, sounds like these three blurbs I found are in agreement with your doctor: Symptoms of GERD may include: a.. Heartburn----a burning feeling in the upper abdomen. It can travel through the chest and into the throat and neck. It is believed to be caused by an acid irritating the esophagus. b.. Regurgitation-a warm, salty, bitter taste in the mouth. It occurs when stomach contents flow back into the esophagus and into the mouth. It frequently occurs with belching. c.. Chest pain----pain in the chest is believed to reflect spasm in the esophagus. It is caused by acid irritating the esophagus. This can mimic a heart attack. d.. Hoarseness or laryngitis----these can develop if the acid and/or stomach contents reach the mouth and throat. e.. Dental disease----occurs because of the effects of the acid on teeth. f.. Choking/Wheezing---may occur especially at night when stomach contents may enter the lungs. This is called aspiration. In patients with asthma, wheezing and shortness of breath may be aggravated by reflux. ---------------------------------------------------------------------------------------------------------------------- Refluxed liquid that passes the larynx can enter the lungs. The reflux of liquid into the lungs (called aspiration) often results in coughing and choking. Aspiration, however, can also occur without producing these symptoms. With or without these symptoms, aspiration may lead to infection of the lungs and result in pneumonia. This type of pneumonia is a serious problem requiring immediate treatment. When aspiration is unaccompanied by symptoms, it can result in a slow, progressive scarring (fibrosis) of the lungs that can be seen on chest x-rays. Aspiration is more likely to occur at night because that is when the processes (mechanisms) that protect against reflux are not active and the coughing reflex that protects the lungs also is not active. -------------------------------------------------------------------------------------------------------------------------------- Gastroesophageal Reflux Disease occurs when the lower esophgeal sphincter (a valve) between the stomach and esophagus weakens. Most probably, affected people are born with this condition. This will lead to leakage of stomach contents (acid, bile, and semi-digested food) into the esophagus, causing heartburn, chest pain and esophagitis. The acid may reach the throat, leading to reflux laryngitis and hoarseness, chronic mostly one-sided sore throat and chronic dry cough. The refluxed acid may enter the windpipe specially when sleeping at night and lead to asthma, recurrent pneumonitis, or chronic lung disease and fibrosis as a result of inflammation of the lungs from aspiration. Yep. It's quite common and well documented. The common drugs used are often pump-inhibitors. However, recent studies suggest that long term use of pump-inhibitors can aggravate asthma in some people. I'll have to re-read the studies to find the mechanism that would cause pump-inhibitors to do that. Reglan seems to work better for me. > Miles, sounds like these three blurbs I found are in agreement > with your doctor: > > Symptoms of GERD may include: > f.. Choking/Wheezing---may occur especially at night when > stomach contents may enter the lungs. This is called aspiration. [quoted text clipped - 27 lines] > recurrent pneumonitis, or chronic lung disease and fibrosis as a > result of inflammation of the lungs from aspiration. You've touched upon another controversial area in GERD, the acid suppressing meds make the GERD less symptomatic and probably lessen damage by making the stomach contents less acidic but they do nothing to stop the stuff from going up into the esophagus. Some believe that they make the reflux worse but I haven't seen proof of that. Some believe that this continued, possibly worse, reflux of less acidic contents is still causing problems and that therefore we should be using motility agents (like Reglan) instead or in addition. The counter arguments are: 1) The acid reducers seem to work, both symptomatically and in terms of esophagitis. 2) Reglan is taken several times per day and has significant side effects, particularly in the elderly. Many surgeons insist that it is an anatomical problem and so the treatment is surgical and call treating with drugs at all complete folly. I think that is probably taking it a bit too far. But it does make it interesting with discussions as it relates to asthma. Maybe GERD triggers asthma by some other ingredient of stomach contents and not acid and so the study I mentioned looked at the wrong drug. Signature00doc "And if you did aspirate your stomach contents to cause scarring of your bronchii you would have likely experienced a chemical pneumonitis and pulmonary fibrosis making asthma the least of your problems. And if that is the case then it is the direct result of the acid being *aspirated* that is causing the problem and not acid reflux per se. " The GERD can cause a reflex constriction of the airways (in theory anyway) or small amount sof aspriation could do something similar but presumably worse without leaving a lot of scarring. I agree that if he was dumping large volumes of stomach contents into his lungs that there would be more to see. Signature00doc rchrdcarlisle@NOTyahoo.com wrote: > So even when you control your acid reflux you still have asthma > symptoms. This means that the acid reflux may just be a contributing > factor in worsening your asthma. About 20 years ago I had a very serious stomach infection that lasted 2 months. It caused massive amounts of acid reflux. That is the time my asthma went from controlled to uncontrollable. During that time Dr.s felt there was no connection to my stomach problems and asthma. It is my belief acid came up and caused scaring of the brochial tubes. My Dr. feels if that happened it may increase sensitivity to allergens and other issues that exacerbate my asthma. The damage per my Dr. would be for the most part permanent and not likely to improve much over the years. So all I can do is attempt to control those things that trigger attacks. > And it may not be the acid reflux per > se that is making the asthma worse. There may be psychologic factors > associated with the acid reflux that is causing the problem. I doubt that. I firmly believe acid reflux is a major contributing factor for asthma. You may have to experience such issues for an extended period of time to understand. I am not a doctor but I agree with you. I believe that acid reflux is one of the causes of asthma and that bacteria is also a cause of asthma. Perhaps someone could provide a list of all of the possible causes of asthma or the URL of a website that has that information. I don't care whether or not people agree with me. Jason rchrdcarlisle@NOTyahoo.com wrote: > Connection does not mean acid reflux causes asthma. Sneezing is > connected with the common cold and yet no one suggests that sneezing > cause the cold. They are associated with each other in a noncausal > fashion. So it is your belief that acid reflux plays no role in causing asthma? I beg to differ. Why? From my own experience. I have GERD. When it acts up for an extended time my asthma gets extremely serious. In such asthma attacks treating the acid reflux is the only thing that is ever effective with me. Like many people there is often multiple contributing factors that trigger their asthma. GERD is one of them. >Remember that correlation does not imply causation. What are you saying? Asthma causes GERD rather than the other way around? In people who's asthma is triggered or aggravated by GERD are you saying treating them for GERD will have zero effect on their asthma? > The operative word is "if". Where is the evidence of this causality. Studies have been done for many years. ACG's studies show very positive results in treating GERD to reduce asthma in patients that suffer from both. Heres another group who firmly believe in acid reflux induced asthma. http://www.infantrefluxdisease.com/reflux_asthma.php I could list 100's of websites but I also realize that Dr's never ever agree on anything. 20 years ago Dr's said positively that asthma could not be cause by GERD. Today I see quite the opposite. Much of what I have seen is my own experience and in talking with my specialists as well as numerous other patients. I read the posts in this thread about acid reflux and wanted to mention a book that deals with the problems related to high acid levels. My niece has acid reflux disease and breathing problems. She has read the book. I have high acid problems and had a serious case of breathing problems and the information in the book helped me to reduce the level of acid. "The Acid-Alkaline Diet" by Christopher Vasey, N.D. www.innertraditions.com or google Healing Arts Press Inner Traditions International > rchrdcarlisle@NOTyahoo.com wrote: > > Connection does not mean acid reflux causes asthma. Sneezing is [quoted text clipped - 3 lines] > > So it is your belief that acid reflux plays no role in causing asthma? My belief is that I don't know the answer to that question. But being afflicted with both asthma and GERD and having asthma improve when GERD improves is hardly proof of causality. It is no more proof that dust causes allergies if someone's asthma improves when dust is not around or whatever other triggers there might be. > I beg to differ. Why? From my own experience. I have GERD. When it > acts up for an extended time my asthma gets extremely serious. In such > asthma attacks treating the acid reflux is the only thing that is ever > effective with me. Like many people there is often multiple > contributing factors that trigger their asthma. GERD is one of them. Your experience hardly proves that GERD causes asthma. It might indicate that GERD exacerbates pre-exisiting asthma but those are two different things. >I read the posts in this thread about acid reflux and wanted to mention a >book that deals with the problems related to high acid levels. My niece >has acid reflux disease and breathing problems. She has read the book. >I have high acid problems and had a serious case of breathing problems and >the information in the book helped me to reduce the level of acid. >"The Acid-Alkaline Diet" by Christopher Vasey, N.D. That book is pure quackery. It was written by some naturopathic quack. There is no such thing as changing the pH of your body by a diet. Your blood pH is tightly controlled by the body. Certain diseases can change the blood pH but diet cannot. You can eat a lot of baking soda and not change your blood pH even though your urine pH may change quite through the effort of the body to maintain the tightly controlled pH. Have not we had this discussion before. Deja vu. RC On Mon, 15 May 2006 10:26:04 -0700, jason@nospam.com (Jason Johnson) wrote: >In article <PdT9g.18195$XV5.14948@fed1read10>, miles <nope@nopers.com> wrote: > [quoted text clipped - 5 lines] > > So it is your belief that acid reflux plays no role in causing asthma? My belief is that I don't know the answer to that question. But being afflicted with both asthma and GERD and having asthma improve when GERD improves is hardly proof of causality. It is no more proof that dust causes allergies if someone's asthma improves when dust is not around or whatever other triggers there might be. > I beg to differ. Why? From my own experience. I have GERD. When it > acts up for an extended time my asthma gets extremely serious. In such > asthma attacks treating the acid reflux is the only thing that is ever > effective with me. Like many people there is often multiple > contributing factors that trigger their asthma. GERD is one of them. Your experience hardly proves that GERD causes asthma. It might indicate that GERD exacerbates pre-exisiting asthma but those are two different things. >I read the posts in this thread about acid reflux and wanted to mention a >book that deals with the problems related to high acid levels. My niece >has acid reflux disease and breathing problems. She has read the book. >I have high acid problems and had a serious case of breathing problems and >the information in the book helped me to reduce the level of acid. >"The Acid-Alkaline Diet" by Christopher Vasey, N.D. That book is pure quackery. It was written by some naturopathic quack. There is no such thing as changing the pH of your body by a diet. Your blood pH is tightly controlled by the body. Certain diseases can change the blood pH but diet cannot. You can eat a lot of baking soda and not change your blood pH even though your urine pH may change quite through the effort of the body to maintain the tightly controlled pH. Have not we had this discussion before. Deja vu. RC Needless to say, I disagree with you. If one person eats high acids foods and drinks high acid drinks for a week--their urine pH levels would be lower than another person that ate low acid foods and drank low acid foods during that same week. At least three doctors agree that "urine pH is crude indicator of the acid-base balance of the body." source: "Laboratory Test Handbook" by David Jacobs M.D, Wayne DeMott, MD and Dwight Oxley M.D > On Mon, 15 May 2006 10:26:04 -0700, jason@nospam.com (Jason Johnson) > wrote: [quoted text clipped - 49 lines] >lower than another person that ate low acid foods and drank low acid foods >during that same week. Did you bother to read what I wrote? You actually agreed with me. I said that there *would* be a change in the *urine* pH if one ate high acid or high base foods but that in the normal individual the change in urine pH would be irrelevant to the blood pH which would remain normal except in certain pathologic conditions. > At least three doctors agree that "urine pH is >crude indicator of the acid-base balance of the body." >source: "Laboratory Test Handbook" by >David Jacobs M.D, Wayne DeMott, MD and Dwight Oxley M.D Urine pH *is* a crude indicator. I completely agree. I never denied this. It is *crude* because despite urine pH being high or low does not mean that the blood pH is abnormal. And it is blood pH that must be kept within a critical narrow range for normal bodily functioning. The urine pH might be high or low due to dietary causes and completely irrelevant to the blood pH. RC On Mon, 15 May 2006 14:48:00 -0700, jason@nospam.com (Jason Johnson) wrote: >In article <f5ph62dks35i3f9713mfnnqiej99ha7oqc@4ax.com>, >rchrdcarlisle@NOTyahoo.com wrote: [quoted text clipped - 48 lines] >lower than another person that ate low acid foods and drank low acid foods >during that same week. Did you bother to read what I wrote? You actually agreed with me. I said that there *would* be a change in the *urine* pH if one ate high acid or high base foods but that in the normal individual the change in urine pH would be irrelevant to the blood pH which would remain normal except in certain pathologic conditions. > At least three doctors agree that "urine pH is >crude indicator of the acid-base balance of the body." >source: "Laboratory Test Handbook" by >David Jacobs M.D, Wayne DeMott, MD and Dwight Oxley M.D Urine pH *is* a crude indicator. I completely agree. I never denied this. It is *crude* because despite urine pH being high or low does not mean that the blood pH is abnormal. And it is blood pH that must be kept within a critical narrow range for normal bodily functioning. The urine pH might be high or low due to dietary causes and completely irrelevant to the blood pH. RC RC, You appear to believe that the diet of a person has no effect upon the blood pH. If you do have this opinion--I disagree with you. I know that doctors prescribe medications to patients that have acid reflux disorder. I know that a doctor that is a kidney specialist wrote a book that includes a diet plan that has various foods that have low levels of acid. He also recommends that kidney patients take baking soda pill and TUMS to reduce the acid level of the body. I believe that some doctors would agree that it's possible to control the blood and urine pH by a change in the diet and by the use of TUMS and Sodium Bicarbonate pills. Jason >RC, >You appear to believe that the diet of a person has no effect upon the >blood pH. Correct. > If you do have this opinion--I disagree with you. Disagree all you want. You are wrong. Blood pH is very tightly controlled in normal adults without some serious metabolic or respiratory disorder. You can eat quite a bit of baking soda and not significantly change your blood pH although your urine pH would change quite a bit. > I know that >doctors prescribe medications to patients that have acid reflux disorder. Yes they do. >I know that a doctor that is a kidney specialist wrote a book that includes >a diet plan that has various foods that have low levels of acid. He also >recommends that kidney patients take baking soda pill and TUMS to reduce >the acid level of the body. Please give me the title and author of this book. > I believe that some doctors would agree that >it's possible to control the blood and urine pH by a change in the diet >and by the use of TUMS and Sodium Bicarbonate pills. Some doctors may also believe that they are Jesus Christ but they would be suffering from a delusion. You are making the logical fallacy of Appeal To Authority. RC >Jason On Mon, 15 May 2006 18:49:47 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >You appear to believe that the diet of a person has no effect upon the >blood pH. Correct. > If you do have this opinion--I disagree with you. Disagree all you want. You are wrong. Blood pH is very tightly controlled in normal adults without some serious metabolic or respiratory disorder. You can eat quite a bit of baking soda and not significantly change your blood pH although your urine pH would change quite a bit. > I know that >doctors prescribe medications to patients that have acid reflux disorder. Yes they do. >I know that a doctor that is a kidney specialist wrote a book that includes >a diet plan that has various foods that have low levels of acid. He also >recommends that kidney patients take baking soda pill and TUMS to reduce >the acid level of the body. Please give me the title and author of this book. "Coping With Kidney Disease" by Mackenzie Walser, M.D. (kidney specialist) Dr. Walser is a Professor of Medicine at Johns Hopkins School of Medicine. He recommends that kidney patients take amino acid supplements (10 g per day). He also recommends that kidney patients take 2 grams of calcium carbonate each day--that's the same substance that is in TUMS. Needless to say, those items mentioned above can raise the urine pH levels but that would not help kidney patients. They would also raise the body pH levels. As I have stated in another post, the urine pH is crude indicator of the acid-base of the body. In other words, when the urine pH is within normal limits (6 to 7.5) on a regular basis--that means the body pH is very likely to be within normal limits. I agree measuring serum pH is a better way of determining the body pH levels, however, most people (unless they work in a lab) are not able to test their serum pH levels on a daily basis. > I believe that some doctors would agree that >it's possible to control the blood and urine pH by a change in the diet >and by the use of TUMS and Sodium Bicarbonate pills. Some doctors may also believe that they are Jesus Christ but they would be suffering from a delusion. You are making the logical fallacy of Appeal To Authority. RC >Jason > On Mon, 15 May 2006 18:49:47 -0700, jason@nospam.com (Jason Johnson) > wrote: [quoted text clipped - 39 lines] >determining the body pH levels, however, most people (unless they work in >a lab) are not able to test their serum pH levels on a daily basis. Unless one has a very specific disease state like kidney failure checking one's urine pH is likely a waste of time. This book is about individuals with incipient kidney failure. It is true that kidney failure can result in an inability of the kidneys to regulate acid base balance in the body. This is one of the exceptions to the rule that checking urine pH is largely a waste of time. As a result of kidney disease the arterial pH becomes abnormal (metabolic acidosis) and in this case bicarbonate can help. But absent kidney failure or other serious conditions that can affect blood pH, urine pH is a largely worthless lab value. The naturopathic doctor who wrote a book about acid base diet is pure quackery as he is suggesting that many people can benefit by making changes that will alter their body acidity and using urine pH to check on efficacy. It is pure bunk. RC > > I believe that some doctors would agree that > >it's possible to control the blood and urine pH by a change in the diet [quoted text clipped - 8 lines] > > >Jason On Tue, 16 May 2006 11:36:57 -0700, jason@nospam.com (Jason Johnson) wrote: >In article <m2di625sf3ediu79dbj0tu06lrr9jg7m3m@4ax.com>, >rchrdcarlisle@NOTyahoo.com wrote: [quoted text clipped - 39 lines] >determining the body pH levels, however, most people (unless they work in >a lab) are not able to test their serum pH levels on a daily basis. Unless one has a very specific disease state like kidney failure checking one's urine pH is likely a waste of time. This book is about individuals with incipient kidney failure. It is true that kidney failure can result in an inability of the kidneys to regulate acid base balance in the body. This is one of the exceptions to the rule that checking urine pH is largely a waste of time. As a result of kidney disease the arterial pH becomes abnormal (metabolic acidosis) and in this case bicarbonate can help. But absent kidney failure or other serious conditions that can affect blood pH, urine pH is a largely worthless lab value. The naturopathic doctor who wrote a book about acid base diet is pure quackery as he is suggesting that many people can benefit by making changes that will alter their body acidity and using urine pH to check on efficacy. It is pure bunk. RC RC, I don't think that people that do not have any health problems should waste their time making use of litmus paper to test their urine pH levels. They should also not waste their time reading the "The Acid-Alkaline Diet for Optimum Health" by Christopher Vasey, N.D. However, I believe that people that have medical problems related to the acid-base balance should read the book and test their urine pH levels. According to the three medical doctors that wrote "Liboratory Test Handbook", these disorders are related to acid-base balance problems: Metabolic Acidosis--also Metabolic alkalosis diabetes mellitus Respiratory acidosis Emphysema Renal Tubular Acidosis Renal Failure Various other types of kidney disease You may think the book is pure bunk but the information in the book is helpful to the people that have the upon mentioned medical problems. Only time will tell if other diseases are related to acid-base balance problems. It's my opinion that acid reflux disease is an acid base balance problem. It's also possible that an acid base balance problem is one of the causes of asthma. Jason >It's my opinion that acid reflux disease is an acid base balance >problem. You know what they say about opinions? Acid reflux disease is a problem with an incompetent gastro-esophageal sphincter. The stomach is normally acidic and there is only a problem when the acid refluxes up past the sphincter, which when performing normally should prevent the acid from making its way up the esophagus into the throat. > It's also possible that an acid base balance problem is one of >the causes of asthma. It is also possible that monkeys will fly out of your butt. But I would not bet on it. But if you have more than just a hunch that acid-base problem is one of the causes of asthma then please post the evidence. What do you think of the large study which did not show a causal relationship between GERD and asthma? We don't know what causes asthma. We do know that many things can exacerbate asthma but exacerbating factors are different from a causal agent. RC >Jason On Tue, 16 May 2006 15:46:27 -0700, jason@nospam.com (Jason Johnson) wrote: >It's my opinion that acid reflux disease is an acid base balance >problem. You know what they say about opinions? Acid reflux disease is a problem with an incompetent gastro-esophageal sphincter. The stomach is normally acidic and there is only a problem when the acid refluxes up past the sphincter, which when performing normally should prevent the acid from making its way up the esophagus into the throat. > It's also possible that an acid base balance problem is one of >the causes of asthma. It is also possible that monkeys will fly out of your butt. But I would not bet on it. But if you have more than just a hunch that acid-base problem is one of the causes of asthma then please post the evidence. What do you think of the large study which did not show a causal relationship between GERD and asthma? We don't know what causes asthma. We do know that many things can exacerbate asthma but exacerbating factors are different from a causal agent. RC RC, I have a niece that has Acid reflux disease. Before she started to take prescribed medications, she used TUMS to treat the problem. It did not work as well to solve the problem as the medication but it did help. Someone recently posted the study results that showed that GERD is one of the possible causes of asthma. Don't ask for proof since I did not make a hard copy of the post. Jason >RC, >I have a niece that has Acid reflux disease. Before she started to take >prescribed medications, she used TUMS to treat the problem. It did not >work as well to solve the problem as the medication but it did help. It is difficult to draw any conclusions from a single anecdote. There may be a number of reasons why her condition improved. It might have been that the TUMS caused the gastro-esophageal sphincter to not be so incompetent. Or she may have gotten better for some other reason. >Someone recently posted the study results that showed that GERD is one of >the possible causes of asthma. Don't ask for proof since I did not make a >hard copy of the post. OOdoc said that a large study had negative results. How can a study show that GERD is one cause of asthma? It might show that it can exacerbate symptoms of asthma but not necessarily cause it. RC >Jason On Tue, 16 May 2006 16:19:25 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >I have a niece that has Acid reflux disease. Before she started to take >prescribed medications, she used TUMS to treat the problem. It did not >work as well to solve the problem as the medication but it did help. It is difficult to draw any conclusions from a single anecdote. There may be a number of reasons why her condition improved. It might have been that the TUMS caused the gastro-esophageal sphincter to not be so incompetent. Or she may have gotten better for some other reason. >Someone recently posted the study results that showed that GERD is one of >the possible causes of asthma. Don't ask for proof since I did not make a >hard copy of the post. OOdoc said that a large study had negative results. How can a study show that GERD is one cause of asthma? It might show that it can exacerbate symptoms of asthma but not necessarily cause it. RC RC, Good point. I should have said that the study that was mentioned in the post indicated that GERD was one of the "possible" causes of asthma. Someone else mentioned another study that indicated that bacteria was also one of the "possible" causes of asthma. Would you agree that there are several causes of asthma. I recall when I researched heart attacks--I found out that there were several different causes of heart attacks. I have a question for you: For the purpose of this discussion, a study is done related to two identical twin brothers that had NO health problems. The two brothers are 60 years years old. One brother only eats high acid foods for one month. The other brother eats foods have that very low amounts of acid during that same month. At the conclusion of the month, the serum and urine pH levels are taken after an 18 hour fast. Will those pH levels be the same or different? It's my opinion that the pH levels of both brothers will be within normal limits but that the serum and urine pH levels of one of the brothers will be lower than the pH levels of the other brother. Jason > Someone else mentioned another study that indicated that > bacteria was also > one of the "possible" causes of asthma. Would you agree that > there are > several causes of asthma. Jason, there are actually several studies that indicate bacteria can cause asthma, and many researchers believe asthma can be a result of more than one thing. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-1705061010350001@66-52-22-64.lsan.pw-dia.impulse.net... > Someone else mentioned another study that indicated that > bacteria was also > one of the "possible" causes of asthma. Would you agree that > there are > several causes of asthma. Jason, there are actually several studies that indicate bacteria can cause asthma, and many researchers believe asthma can be a result of more than one thing. That was my opinion based upon my own research. Thanks for letting me know the facts that you mentioned in your post. What are the other possible causes of asthma? Do you believe that acid-base problems could be a possible cause of asthma? I know of one patient that has all sorts of health problems related that may have been caused because of acid-base problems--including asthma. The patient has an eating disorder--obese--and refuses to even consider changing her diet and eating only low acid foods. She drinks about 5 cups of coffee per day and drink lots of cokes each day. She takes about a dozen different medications each day. Jason > That was my opinion based upon my own research. Thanks for > letting me know the facts that you mentioned in your post. [quoted text clipped - 11 lines] > different medications each day. > Jason Defective airways can cause asthma, so can smoking or inhaling chemicals or gases. There aren't any studies that I know of, but I've read of several cases where asthma began with exposure to mold. I know nothing about acid-based problems, but based on what you've written with regard to the obese patient, I don't think I would buy it. The coke alone can make someone obese, and the sugar can set off binge eating in people who crave high carb diets. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-1705061201310001@66-52-22-52.lsan.pw-dia.impulse.net... > That was my opinion based upon my own research. Thanks for > letting me know the facts that you mentioned in your post. [quoted text clipped - 11 lines] > different medications each day. > Jason Defective airways can cause asthma, so can smoking or inhaling chemicals or gases. There aren't any studies that I know of, but I've read of several cases where asthma began with exposure to mold. I know nothing about acid-based problems, but based on what you've written with regard to the obese patient, I don't think I would buy it. The coke alone can make someone obese, and the sugar can set off binge eating in people who crave high carb diets. She has been to several different doctors in search of some magic cure. Her doctors are not sure of the source of her asthma problems. They treat each of her 5 (or more) health problems with 5 or more types of medications. It's my guess that many of her problems are related to an acid-base problem. She may now have Addison's disease as a direct result of medications she is taking to treat asthma. Since she refuses to change her diet, I doubt that her health problems will ever improve. Thanks for answering my questions. Jason >RC, >Good point. I should have said that the study that was mentioned in the >post indicated that GERD was one of the "possible" causes of asthma. >Someone else mentioned another study that indicated that bacteria was also >one of the "possible" causes of asthma. Would you agree that there are >several causes of asthma. No I would not. I would agree that there are many things that can exacerbate and trigger as asthma attack but as far as the cause I just don't know. It could be one thing or several. It might just be that individuals who develop asthma get it due to genetic factors and that there is not much they can do to prevent it other than to avoid those things that exacerbate it. Perhaps they will find the genetic cause in the future. Anyone who thinks that they know the cause of asthma is just speculating. > I recall when I researched heart attacks--I >found out that there were several different causes of heart attacks. There is one cause of heart attack and that is lack of oxygen to the heart. Now there are many things that can cause this lack of oxygen such as an embolus or narrowing of coronary arteries but the proximate cause is the same. >I have a question for you: >For the purpose of this discussion, a study is done related to two [quoted text clipped - 5 lines] >At the conclusion of the month, the serum and urine pH levels are taken >after an 18 hour fast. Will those pH levels be the same or different? Probably different. >It's my opinion that the pH levels of both brothers will be within normal >limits but that the serum and urine pH levels of one of the brothers will >be lower than the pH levels of the other brother. I agree. So what? The body deals with the excess acid by excreting it in the urine in order to maintain blood pH within a narrow limit that is important for good health. RC >Jason On Wed, 17 May 2006 10:10:35 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >Good point. I should have said that the study that was mentioned in the >post indicated that GERD was one of the "possible" causes of asthma. >Someone else mentioned another study that indicated that bacteria was also >one of the "possible" causes of asthma. Would you agree that there are >several causes of asthma. No I would not. I would agree that there are many things that can exacerbate and trigger as asthma attack but as far as the cause I just don't know. It could be one thing or several. It might just be that individuals who develop asthma get it due to genetic factors and that there is not much they can do to prevent it other than to avoid those things that exacerbate it. Perhaps they will find the genetic cause in the future. Anyone who thinks that they know the cause of asthma is just speculating. > I recall when I researched heart attacks--I >found out that there were several different causes of heart attacks. There is one cause of heart attack and that is lack of oxygen to the heart. Now there are many things that can cause this lack of oxygen such as an embolus or narrowing of coronary arteries but the proximate cause is the same. >I have a question for you: >For the purpose of this discussion, a study is done related to two [quoted text clipped - 5 lines] >At the conclusion of the month, the serum and urine pH levels are taken >after an 18 hour fast. Will those pH levels be the same or different? Probably different. >It's my opinion that the pH levels of both brothers will be within normal >limits but that the serum and urine pH levels of one of the brothers will >be lower than the pH levels of the other brother. I agree. So what? The body deals with the excess acid by excreting it in the urine in order to maintain blood pH within a narrow limit that is important for good health. RC RC, Do you now agree that diet can have an effect upon the blood and urine pH levels? Jason > On Tue, 16 May 2006 15:46:27 -0700> wrote: > You know what they say about opinions? Am I the only one laughing at the irony? > rchrdcarlisle@NOTyahoo.com wrote: > > Connection does not mean acid reflux causes asthma. Sneezing is [quoted text clipped - 41 lines] > Healing Arts Press > Inner Traditions International Oh Lord help us. First the B* brigade, the ozone charlatans, the Juice people, the cell salt maniac, the iron loony, and now we have Jason the acid wacko. I shudder to think of who is next. Life is uncertain............eat dessert first!! Nancy 8=: ) > Oh Lord help us. First the B* brigade, the ozone charlatans, > the Juice people, the cell salt maniac, the iron loony, and now [quoted text clipped - 6 lines] > Nancy > 8=: ) You forgot the broken record on hidden food allergies. > You forgot the broken record on hidden food allergies. Oh I found my hidden food allergy. I used to drink orange juice and vodka and I got sick the next morning. So I switched to orange juice and gin but I got sick too. So then I changed to orange juice and tequila. But, once more the next morning I felt awful. So I realized it must be the orange juice I'm allergic too. >> You forgot the broken record on hidden food allergies. > [quoted text clipped - 4 lines] > felt awful. So I realized it must be the orange juice I'm > allergic too. You should write a book! And get your license in naturopathy!! And then advertise in the yellow pages!!! Aaaaaaaaaaahhhhhhhhhhhhhhhhh!!!!!!!!!!!!!!!!!!!!!!!!!!!!! > Aaaaaaaaaaahhhhhhhhhhhhhhhhh!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Yeah, I'm at this point, too....lol. There certainly is an association between asthma and GERD. It has never been well established if one (or its treatments) casues the other or if something else is predisposing to both There are plausible theories to explain both how asthma might worsen GERD and how GERD might worsen asthma. Despite a dearth of supporting evidence it has been widely assumed that GERD worsens asthma and so GERD has been aggressively sought and treated, especially in recalcitrant asthma cases. Recently, there was a large randomised trial loking at treating GERD in asthma patients that showed no benefit. Some editorialists have declared it a death knell for the GERD triggering asthma theory but I am not so sure for several reasons: 1) Although it was large and well done it is still only one study. Always be cautious about generalizing the results of any one study. 2) IIRC it was done in kids so it might not generalize to adults. 3) I don't think it can exclude the possibility that there is a subset od asthmatics who are triggered by GERD ans who will benefit from treatment. My take is that the study has causes me to wonder a little more about the theory and be much less aggressive about looking for it and trying meds but I still consider it worth a try in some cases, especially if the person is having GERD symptoms. Besides the symptoms often warrant treatment independant of the asthma. I think another thing that may be provoking some angst is the word "causes". On this group claims of knowing the cause of asthma are often followed by sales pitches for quack cures. I know you are not selling anything but it does make people nervous. It would probably be more accurate to say it exacerbates asthma symptoms. Signature00doc >It would probably be more >accurate to say it exacerbates asthma symptoms. Indeed. And that was my main point when someone said that GERD caused asthma. Thanx for the information about the study that is negative for improvement in asthma after treatment for GERD. You are also correct that definitive conclusions cannot be arrived at since it is only one study. But it does call into question the original hypothesis. Hopefully the study will be repeated to confirm the negative result. Repeatability is important. But there are those who are so convinced based upon personal experience that GERD exacerbates asthma that no number of negative studies would be sufficient to convince them otherwise. I still contend that psychologic factors may be at work to explain the phenomenon. If someone has GERD and happens to have a flare up of their asthma they may understandably connect the GERD to the asthma so the next time the GERD flares up, anxiety about asthma may worsen that condition. Anxiety may either exacerbate bronchial hypersensitivity or lead to a panic attack that results in perception of inability to catch one's breath. Over time the connection between GERD and asthma may become ingrained causing exacerbation of the asthma symptoms. RC > But there are those who are so convinced based upon personal > experience that GERD exacerbates asthma that no number of negative > studies would be sufficient to convince them otherwise. It really is a firmly entrenched belief. I breifly tried to search for the study I mentioned but on general search engines it is hard to find terms that do not leave you swamped with websites discussing how GERD triggers asthma. It is amazing how this is stated so far and wide with absolutely no objective evidence to support it. GERD is a tough subject. It is hard to diagnose - 25% of cases show no changes in the esophagus (called NERD - non-erosive reflux disease) so the only reliable way is with a pH probe study combined with symptom diaries but very few studies look at those. They usually just do upper endoscopies and presumably miss a lot of cases. Some studies just look at symptoms but those are notoriously innaccurate. Then they use acid blocking meds which reduce the acidity of refluxed material but not the material from refluxing (and assume it is the acid that is having the effect). The acid blocking drugs also make it hard to follow the patients since they will nullify symptoms, turn pH probe studies negative, and reduce esophagitis all without reducing reflux. So basically you have a population that is hard to characterise, hard to treat and hard to monitor treatment. is it any wonder that good data is lacking? What I would love to see them do is a study that truly reduced reflux, either by surgery or pro-kinetic agents (like Reglan, Propulcid, or Zelnorm), used pH probes to prove they did reduce the reflux, and then follow objective asthma markers. One problem with that is that it would be nearly impossible to blind (although I have a few ideas of how that could be done). Signature00doc >> But there are those who are so convinced based upon personal >> experience that GERD exacerbates asthma that no number of negative >> studies would be sufficient to convince them otherwise. > >It really is a firmly entrenched belief. It appears to border on the delusional. Simply my *questioning* whether what they say is not true results in tremendous anger in some people. > I breifly tried to search for the >study I mentioned but on general search engines it is hard to find terms >that do not leave you swamped with websites discussing how GERD triggers >asthma. Why search on general engine? Medline is your friend. >It is amazing how this is stated so far and wide with absolutely no >objective evidence to support it. Not really. There is a lot of sh.t on the internet with no supporting data. Just look at all the anti-vac whackos. Do a general search for vaccination and you will see how many loons there are out there. You would think by reading some of this garbage that if you vaccinate your kid that they will either immediately die or get some godforaken disease. >GERD is a tough subject. It is hard to diagnose - 25% of cases show no >changes in the esophagus (called NERD - non-erosive reflux disease) so the >only reliable way is with a pH probe study combined with symptom diaries but >very few studies look at those. And if you don't do these studies then the Dx is made based upon subjective complaints which is notoriously fraught with problems. >So basically you have a population that is hard to characterise, hard to >treat and hard to monitor treatment. is it any wonder that good data is >lacking? Not surprising at all. > What I would love to see them do is a study that truly reduced >reflux, either by surgery or pro-kinetic agents (like Reglan, Propulcid, or >Zelnorm), used pH probes to prove they did reduce the reflux, and then >follow objective asthma markers. One problem with that is that it would be >nearly impossible to blind (although I have a few ideas of how that could be >done). Why would it be hard to blind if you used medication? Surgery is a different matter altogether although there have been studies with sham surgery. Not sure how they got past the ethics committee on that though. RC > Why search on general engine? Medline is your friend. If I get real serious that is what I will have to do. It is recent enough that I may be able to jst look at some recent stuff I have at home. Sometiems the computer gives too much info. > Just look at all the anti-vac whackos. Do a general > search for vaccination and you will see how many > loons there are out there. You would think by reading > some of this garbage that if you vaccinate your > kid that they will either immediately die or get > some godforaken disease. I used to read misc.kids.health. I could give you the names of several of those whackos off the top of my head. >Why would it be hard to blind if you used medication? > Surgery is a different matter altogether although there > have been studies with sham surgery. Not sure how > they got past the ethics committee on that though. Sham surgeries can be ethical. Just do little enough cutting that it is not much of a risk to the patient. The problem with blinding the meds is that all the motility drugs have significant side effects. You would need to use a placebo that causes similar side effects. It is doable but would take more thought. Signature00doc > It really is a firmly entrenched belief. I breifly tried to > search for the study I mentioned but on general search engines > it is hard to find terms that do not leave you swamped with > websites discussing how GERD triggers asthma. It is amazing how > this is stated so far and wide with absolutely no objective > evidence to support it. You must be talking about the study theyr'e doing at Ohio State Medical Center? I think it's entrenched because studies have shown there's a relationship between GERD and asthma - they just don't know how it works. Yoohooo - Mr. Busyman. I take that to mean NO? It's not the OSU study? >> It really is a firmly entrenched belief. I breifly tried to >> search for the study I mentioned but on general search engines [quoted text clipped - 9 lines] > relationship between GERD and asthma - they just don't know how > it works. > Yoohooo - Mr. Busyman. I take that to mean NO? It's not the OSU study? I finally had time to look for it. It was done in Norway: Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease. Stordal K, Johannesdottir GB, Bentsen BS, Knudsen PK, Carlsen KC, Closs O, Handeland M, Holm HK, Sandvik L. Dept of Paediatrics, Ostfold County Hospital, 1602 Fredrikstad, Norway. ketil.stoerdal@c2i.net BACKGROUND: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. AIM: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. METHODS: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. RESULTS: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment. CONCLUSION: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD. However, while look for that one I also came across this: The influence of gastroesophageal reflux disease and its treatment on asthmatic cough. Bocskei C, Viczian M, Bocskei R, Horvath I. Koranyi National Institute for TB and Pulmonology, Budapest, Hungary. csbockei@freemail.hu Gastroesophageal reflux is known to cause chronic cough and is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux disease (GERD) in asthmatic patients with chronic cough to analyze the temporal relationship between reflux events and coughing and to assess the effect of esomeprazole treatment on respiratory symptoms and lung function in these patients. Asthmatic patients (126) with chronic dry cough were studied. Diagnosis of GERD was based on typical symptoms and the effectiveness of therapeutic test or on pH monitoring. Patients without GERD (negative pH results) consisted of the control group. The results of pH monitoring showed that 64% of cough episodes were related to acid reflux and in 91% of reflux events preceded coughing. Esomeprazole treatment (40 mg/day for 3 months) not only diminished GERD symptoms but also improved asthma outcome Baseline FEV(1) and PEF values increased significantly together with a decrease in symptom scores and the use of rescue medication. In most patients included in the extended part of the study for another 3 months, the dose of inhaled steroids could be reduced with sustained GERD therapy. Our data showing that reflux events preceded coughing in most cases and that treatment of GERD resulted in an improvement in different outcome measures of asthma suggest that GERD worsens asthma, and its treatment is of clinical importance to effectively manage these patients. Whether it is a difference between adults and children of something else I don't know. Signature00doc |
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