The link between asthma and GERD

It is not known whether treatment of GERD with PPIs in patients who have poorly controlled asthma without symptom of GERD can improve asthma control..

Is there a link between asthma and GERD? Gastroesophageal reflux (GERD) is common among patients with asthma but often causes mild or no symptoms. Some asthma patients are given a PPI, even if they don't have typical GERD symptoms such as heartburn...

That's because even patients without overt GERD symptoms could still have acid reflux. And aspiration of the acid can make airways constrict → leading to cough, chest tightness, or shortness of breath. Plus, using beta-agonists (albuterol, etc) for asthma may relax the esophageal sphincter and make acid reflux more likely. But researchers are questioning this link. The latest evidence suggests that esomeprazole (Nexium) does NOT improve asthma symptoms in patients with poorly controlled asthma and without typical GERD symptoms.

Don't count on a PPI to improve asthma. But consider trying one if patients still have a cough or nocturnal symptoms that could indicate acid reflux. Stop the PPI if symptoms don't improve in about 8 weeks.

References

Efficacy of Esomeprazole for Treatment of Poorly Controlled Asthma. (2009). New England Journal of Medicine, 360(15), pp.1487–1499. Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa0806290
NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals.
Guidelines for the Diagnosis and Management of Asthma (EPR-3). National Heart, Lung, and Blood Institute (NHLBI). [online] Available at: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma.
Boulet LP. Influence of comorbid conditions on asthma. Eur Respir J. 2009 Apr;33(4):897-906.