ABSTRACT
Retrograde movement of gastric contents into the esophagus is gastroesophageal reflux (GER). While both asthma and gastroesophageal reflux disease (GERD) are common in the general population, mounting data place GERD as a substantial contributor to asthma in many patients. There is a higher prevalence of GERD in patients with asthma than in the general population, and recent studies have begun to shed light on the mechanisms by which GERD alters airway function. Importantly, improvement in asthma with newer and more effective treatment of GERD underscores the importance of its identification and treatment. The fact that GERD can be silent in as many as 33% of adults with asthma (1,2) and 44% of infants with daily wheezing (3) necessitates a high index of suspicion, even in the absence of symptoms. Furthermore, evidence suggests that just as GERD can exacerbate asthma, asthma can exacerbate GERD, establishing a vicious cycle. As such, GERD must always be considered in the treatment of the patient with severe asthma. It should be noted, however, that most of our research on asthma and GERD that demonstrates their intimate
association and interlocked mechanisms and treatment has been conducted in populations without regard to stratification for disease severityÐfor either asthma or GERD. Hence the discus-sion of GERD in severe asthma must at times be drawn from indirect and imper-fect data.
