Abstract
The coincidence of asthma and pathological gastrooesophageal or extraoesophageal reflux is common and the two diseases often adversely affect each other through different mechanisms. Clinical manifestations of pathological gastrooesophageal and extraoesophageal reflux may mimic asthma or affect the assessment of asthma control.
The underlying mechanisms are the vagus nerve-mediated reflex, increased bronchial reactivity, microaspiration and alteration of the immune system response. In contrast, bronchial obstruction causes increased negative pleural pressure and affects the thoracoabdominal gradient.
Systemic corticosteroids used in the treatment of severe asthma have a negative effect on reflux, while the adverse effect of other asthma medications is questionable. Every patient with asthma should be asked about reflux symptoms, although many of them do not present with any such problem.
The methods that can be used in diagnosing gastrooesophageal and extraoesophageal reflux include esophagogastroduodenoscopy and two-channel 24-hour pH-measurement; typical signs of reflux can be detected by laryngoscopy and bronchoscopy. PH-measurement in the oropharynx and Peptest are less common tests.
Another option is a diagnostic-therapeutic test. Apart from lifestyle and dietary changes, the mainstay of treatment for gastrooesophageal and extraoesophageal reflux are proton pump inhibitors and prokinetic agents, particularly suitable for the treatment of extraoesophageal reflux.
Treatment of reflux positively influences asthma control.