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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

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Asthma Facts and Figures

Asthma Facts and Figures from the Asthma and Allergy Foundation of America (aafa.org)

May is Allergy and Asthma Awareness Month

What Is Asthma?

  • Asthma is a long-term disease that causes inflammation and swelling of the airways. This results in narrowing of the airways that carry air from the nose and mouth to the lungs.
  • Asthma symptoms include trouble breathing (shortness of breath), wheezing, coughing, and tightness or pain in the chest.
  • Asthma symptoms can be triggered by different things for different people. Allergens, like dust or pet dander, are common triggers. Some people also develop asthma symptoms in response to certain foods or to exercise.

    Asthma can be deadly.

  • There is no cure for asthma, but appropriate treatment prevents asthma attacks and can help you have a better quality of life.
  • Asthma is one of the most common and costly diseases in the United States.

    How Common Is Asthma?

  •  Approximately 25 million people in the U.S. have asthma. This equals about 1 in 13 people.
  • About 20 million U.S. adults age 18 and older have asthma.
  • Asthma rates are highest in Black adults in the U.S.
  • Asthma is more common in female adults than male adults. Around 9.8% of female adults have asthma, compared to 6.1% of male adults.
  • It is a leading chronic disease in children.2 Currently, there are about 5.1 million children under the age of 18 with asthma.
  • Black children are nearly three times more likely to have asthma compared to white children.
  • Asthma is more common in male children than female children. Around 8.4% of male children have asthma, compared to 5.5% of female children.

What Are the Rates of Asthma Attacks in Children?

  • In 2019, 44.3% of children age 18 and younger who had asthma reported having one or more asthma attacks in the past year.
    • About 47.2% of children under the age of 5 with asthma had an attack. 1
  • According to the Centers for Disease Control and Prevention (CDC), asthma attacks in children have declined from 2001 through 2019.
  • Even though asthma is controllable, it is estimated that 50% of children with asthma have uncontrolled asthma.

What Are the Rates of Asthma Attacks in Adults?

  • In 2019, 40.4% of adults age 18 and older who had asthma reported having one or more asthma attacks in the past year.
    • Black adults have the highest rate of asthma attacks in the U.S.
  • According to the CDC, asthma attacks in adults have declined from 2001 through 2019.3 2

How Many People Seek Medical Care for Asthma?

  • In 2018, asthma accounted for 5.8 million doctors’ office visits.
  • In 2018, asthma accounted for 178,530 discharges from hospital inpatient care and 1.6 million emergency department visits.
  • Black people in the U.S. are nearly five times more likely than white people in the U.S. to visit the emergency department due to asthma.

How Many People Die From Asthma?

  • On average, 11 people in the U.S. die from asthma each day. In 2020, 4,145 people died from asthma. Nearly all of these deaths are avoidable with the right treatment and care. In 2020, deaths due to asthma rose for the first time in 20 years.
  • Adults are five times more likely to die from asthma than children.
  • Female adults are more likely to die from asthma than male adults, and male children are more likely than female children.
  • Black people in the U.S. are nearly three times more likely to die from asthma than white people in the U.S.
  • When sex is factored in, Black females have the highest rate of fatality due to asthma. In 2020, Black females were nearly four times more likely to die from asthma than white males.

What Are the Costs of Asthma?

  • From 2008-2013, the annual economic cost of asthma was more than $81.9 billion – including medical costs and loss of work and school days:9 o $3 billion in losses due to missed work and school days
    • $29 billion due to asthma-related mortality o $50.3 billion in medical costs
  • Medical costs for people with asthma are estimated to be $3,266 higher per year (in 2015 U.S. dollars) compared to medical costs for people without asthma.
  • Among children ages 5 to 17, asthma is one of the top causes of missed school days. In 2013, it accounted for more than 13.8 million missed school days.

Why Do Certain Racial or Ethnic Groups Have Higher Rates of Asthma,Asthma Attacks, or Asthma Deaths?

See AAFA’s groundbreaking research report on Asthma Disparities in America. Racial and ethnic differences in asthma frequency, illness, and death are caused by complex factors, including:

  • Structural determinants such as systemic racism, segregation, and discriminatory policies
  • Social determinants such as socioeconomic status, education, neighborhood and physical environment, employment, social support networks, and access to health care
  • Biological determinants such as genes and ancestry
  • Behavioral determinants such as tobacco use and adherence to medicines
  • Social determinants and structural inequities (systemic racism) largely drive disparities in asthma. Factors such as genetics and individual behaviors contribute less to asthma disparities.

Why Do Males and Females Have Different Rates of Asthma?

  • Male children are more likely to have asthma than female children. This trend reverses in adulthood, where female adults are more likely to have asthma than male adults.
  • Some studies suggest this trend reverses because of the effects of testosterone on lung cells. Testosterone, a male sex hormone, has been found to decrease the swelling of the airways in asthma.

The post Asthma Facts and Figures appeared first on Oklahoma Allergy and Asthma Clinic.

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