![]() ![]() ![]() Almost half of the 189 had supine nocturnal heartburn and 18% had nocturnal burning in the throat. 13 reported that 72% of 189 consecutive asthmatics had heartburn. 12 found evidence of reflux symptoms in 65% of 150 consecutive (enrolled as they were identified not referred or selected for the study) asthmatics. In the first study, Perrin-Fayolle et al. Prevalence of Gastroesophageal Reflux Disease in Asthmatic Adults Gastroesophageal Reflux Disease Defined as Reflux Symptomsįigure 2 shows the prevalence of GER symptoms in adult asthmatics in four studies with sufficient interpretable data. Thus, more than 60% of these patients, who were being referred for surgery to correct a gastroesophageal abnormality, actually had respiratory symptoms. Figure 1 shows the results of their 5-year experience (from 1961 to 1966) in 636 patients ranging in age from 7 months to 94 years who were referred for surgical correction of GER: 39% had classic reflux symptoms consisting of heartburn, indigestion, and postural aggravation without respiratory symptoms 45% had both reflux symptoms and respiratory symptoms and 16% had respiratory symptoms only. ![]() Soon after, Urschel and Paulson 11 reported in 1967 their experience in patients who were referred for hiatal hernia repair. Bray's comments, however, went relatively unnoticed until Belsey, 10 in a review on pulmonary complications of esophageal disease, reported that patients with GER were liable to severe, progressive, and disabling pulmonary damage. Bray, 9 who reported that dietary indiscretion in some patients could lead to asthmatic attacks. For the next 50 years, only a few scattered wheezes were heard amidst the competing voices of subspecialty medicine's bellowing burps and clamoring coughs. Asthma is very heterogeneous over time in individual asthmatics and is heterogeneous in different asthmatics.ĭuring the 18th century, Nicholas Rosen von Rosenstein, 6 the First Physician to His Swedish Majesty, discussed in his 1776 textbook, The Diseases of Children and Their Remedies, what he terms the stomachic cough of children: "Such a cough is caused by the natural proclivity of children to ingest huge quantities of disgusting food, that cannot be digested or changed as it ought." Twenty-six years later, in his 1802 textbook, The History and Cure of Diseases, William Heberden 7 wrote, "In most persons, the breath is shorter and more difficult after a meal."Īlmost a century later, in 1892, Sir William Osler 8 published The Principles and Practice of Medicine in which he prepared for the 20th century with an emphasis on eating habits: "Diet, too has an important influence and in persons subject to this disease severe paroxysms may be triggered by overloading the stomach, or by taking certain articles of food." In the same chapter, Osler again suggested that particular attention be paid to the diet of the asthmatic: "A rule of which experience generally compels them to make is to take the heavy meal in the early part of the day and not retire to bed before gastric digestion is completed."ĭespite the emphasis on diet and the strong references to a relationship between food, eating habits, and asthma, the GER/asthma concept remained difficult to swallow. This fact is why the interactions between the two disease states are very complex and asthma outcomes with GER therapy are difficult to interpret. Therefore, treatment of GER in asthmatics treats a potential contributing condition, not asthma itself. 5 Although GER may be a trigger in an individual asthmatic, GER therapy does not "cure" asthma. Gastroesophageal reflux ( GER) is a potential trigger or contributing factor in selected (not all) asthmatics. 2 Asthma varies in severity over time in individual asthmatics. 4 Genetic factors also predispose to asthma development. 2, 3 Most people with asthma have multiple triggers and contributing conditions. 2, 3 There are many triggers and contributing conditions that can initiate bronchospasm and airway inflammation. 2, 3 Airway inflammation is also a key feature of asthma and results in alterations in the mucosa and submucosa that over time lead to airway remodeling. One should not sleep during the day.Īsthma is a disease characterized by bronchoconstriction, which is partially reversible. One should not go to sleep immediately after a meal, but only when three or four hours have elapsed. One should not sleep face downwards, nor on one's back, but lying on the side at the beginning, on the left side, and the close of one's rest, on the right side. 1 Writing of an association between eating, lying down, and wheezing, Maimonides suggested in his Treatise on Asthma, that sleep was dangerous during an attack: The 12th century physician-philosopher, Moses Maimonides, strongly warned against overeating. The relationship between GER and asthma has been pondered for millennia. ![]()
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