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Acid Reflux

Acid reflux or GERD occurs when gas, liquid or food particles in the stomach return back up the esophagus (food tube) into the back of the throat (pharynx), mouth, nose, sinuses, middle ear tube (Eustachian tube), or middle ear. This results in irritation (inflammation) and discomfort of these areas. It is important to note that patients don’t always feel the irritation and the symptoms can be ‘silent’. When this occurs, your doctor might see evidence on your physical exam or note other symptoms that are concerning for reflux.

When the reflux enters the upper airway, it is called laryngeal pharyngeal reflux or LPR. When this occurs, it is called GERD/LPR. Unfortunately, up to 60% of the population will have reflux one or more times per week.

As many as 75% of individuals with asthma are at a higher risk of experiencing acid reflux symptoms. In fact, asthmatics are twice as likely to have GERD. Many severe asthmatics have GERD that makes their asthma more challenging to treat. The stomach contents may trigger nerves associated with asthma (particularly cough) or can actually enter the airways (aspiration) resulting in spasm, irritation and asthma symptoms. For these reasons, reflux needs to be considered in individuals with asthma.

Signs and Symptoms of GERD/LPR

  • Nasal congestion and sometimes runny nose
  • Postnasal drainage
  • Cough
  • Hoarseness (particularly in the morning), throat irritation/burning
  • Unusual or bitter taste in the mouth or the back of the throat (brackish water)
  • Difficulty swallowing or choking (particularly at night)  Recurrent sore throat, pneumonia, bronchitis, sinusitis, or ear infections
  • Constant throat clearing
  • Bad breath (halitosis)
  • Burning chest pain (can mimic heart attacks)
  • Abdominal fullness, gas, or belching after meals
  • Chest pain, burning or tightness in the chest after lying down or bending over

If GERD/LPR is diagnosed, your physician may recommend using medications to help block the effects of acid secretion. Anti-acids (like Rolaids or Tums) weaken and neutralize the acid in your stomach, but don’t affect the production of acid and don’t work to prevent symptoms. H2 blockers (like Zantac or Pepcid) lessen the production of acid in your stomach and help prevent symptoms. They tend to work longer but are not quick to act so they don’t alleviate symptoms quickly. Proton Pump Inhibitors or PPIs (like Prilosec, omeprazole or Nexium) are longer acting and make acid less prevalent in the gut. They work by preventing symptoms and must be taken on an empty stomach 30 minutes prior to eating.

All medications including those for acid reflux have potential side effects and these can be discussed with your provider.

Measures That May Help Alleviate Symptoms of GERD/LPR:

  • Elevate the head of your bed 6-8 inches (This can be done by placing the top bedposts on cinder blocks or using a wedge under the top of the mattress. Elevating your head on pillows is not as effective.)  Eat smaller, more frequent meals rather than large ones.
  • No eating or drinking at least 3-4 hours before bedtime.
  • Drinking fluids of any type before bedtime can result in stretching the stomach opening resulting in reflux.
  • Do not skip meals. This can actually result in a 15% increase in daily caloric intake. Skipping meals usually result in overeating of the remaining meals, which can overfill your stomach and increase acid reflux.
  • Lose weight, if needed. We know that those who are overweight do not respond as well to GERD meds as those who are of healthy weight.
  • Avoid bending over, straining, constipation or wearing tight clothes around the abdomen.

Eliminate the following foods and beverages (totally, if all possible)

  • Caffeinated and/or decaffeinated products
  • Alcohol
  • Carbonated beverages of any type
  • Chocolate
  • Mint (includes gums and toothpaste)
  • All types of citrus
  • Fried foods (includes many spicy or fatty foods)
  • Nicotine of any type
  • Dairy

Recent News

SuperUser Account
/ Categories: News

AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief

Chronic Sinusitis’s Impact on Asthma

Asthmatics can add chronic rhinosinusitis (CRS) as a related condition, and one that has a significant health impact, according to new research.

In the study, patients with asthma who also had a chronic bronchial condition were the most likely to have CRS – and to feel the effects of this disease combination. The new findings will be presented at the 2022 annual meeting of the AAAAI (American Academy of Allergy Asthma & Immunology) in Phoenix in late February.

To conduct the study, researchers from Northwestern and Johns Hopkins universities analyzed medical records from 1988 to 2021 on those with asthma, who had CRS and/or bronchiectasis. In the latter chronic condition, the airway walls become thick and damaged. The patient experiences mucus buildup, coughing, and lung infections.

The sinus condition CRS lasts for more than 12 weeks, even with medication, and includes symptoms such as nasal congestion, facial pressure and thick nasal discharge.  

The team studied records spanning more than three decades to capture as many patients as possible, and to follow patients with asthma who did not initially have bronchiectasis, says study author Dr. Margaret Kim.

To measure the impact of CRS on patients with asthma and bronchiectasis, the researchers examined the use of medication, such as antibiotics and oral corticosteroids, along with the need for urgent health care. Of the 5,038 patients identified with asthma, 19 percent had bronchiectasis, 39 percent had CRS, and 10 percent had both conditions.

The study found that 51 percent of asthmatics who had bronchiectasis were more likely to have CRS than patients without it (36 percent).

Need for Medical Attention

The findings point to greater use of health-care resources among that 51 percent of asthma patients. The use of medications and the rate of hospital admissions and emergency room visits were all higher. The researchers conclude that CRS is an important to be aware of, especially in asthma patients with bronchiectasis.

The study is important as more patients are being diagnosed with bronchiectasis, which is associated with high health-care costs and requirements, said Kim, a clinical fellow in allergy and immunology at Northwestern University’s Feinberg School of Medicine.

“This knowledge helps identify patients who need more medical attention,” she said.

To help the identification process, providers can routinely ask about symptoms of CRS in patients who have asthma and bronchiectasis, and patients with CRS. Kim says patients with CRS should also be screened for bronchiectasis if they have symptoms that could suggest the condition, such as a cough with phlegm and difficulty controlling asthma.

Asthma Relief for All Seasons

Patients taking the biologic drug tezepelumab experienced fewer asthma exacerbations during all seasons throughout the year than those taking the placebo as part of a Phase 3 clinical trial, according to results to be presented at the 2022 AAAAI meeting.

Researchers focused on asthma exacerbations based on each season when they analyzed the results of the study called Navigator. That trial divided more than 1,000 teen and adult patients with poorly controlled asthma and frequent exacerbations into two groups. Participants received by injection either tezepelumab or placebo every four weeks for a year (but did not know which, as the trial was “blinded”). The participants also remained on their standard asthma regimens of inhaled corticosteroid inhalers, plus at least one additional controller medication. 

Tezepelumab reduced the annualized asthma exacerbation rate in the 528 patients taking the drug by 63 percent in winter, 46 percent in spring, 62 percent in summer, and 54 percent in fall, according to the study. Compared to those taking the placebo, patients taking tezepelumab had fewer exacerbations in winter (81.7 percent vs. 66.6 percent), spring (84.3 percent vs 76.3 percent), summer (86.8 percent vs 73.1 percent) and fall (79.4 percent vs. 66.6 percent), the study found.

Tezepelumab is a monoclonal antibody designed to work at an early stage of immune system response in the airways, blocking TSLP (thymic stromal lymphopoietin). TSLP is a type of cytokine, or signaling molecule, that triggers immune defenses. In response to a trigger, TSLP cytokines set off a cascade of airway inflammation that leads to asthma symptoms.

In December 2021, the FDA approved Tezspire (tezepelumab-ekko) injection as an add-on maintenance treatment to improve severe asthma symptoms when used with a patient’s current asthma medicine.

To read the entire article online, visit https://www.allergicliving.com/2022/02/03/aaaai-news-sinusitiss-impact-on-asthma-shot-brings-4-season-relief/

The post AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief appeared first on Oklahoma Allergy and Asthma Clinic.

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