Is It Rhinitis, Gastric Reflux or Asthma
- Andrew:
- Is there a connection between asthma and this type of rhinitis you’re talking about? I also heard that there could be a connection with gastric reflux and [reflux] could affect the upper respiratory system too. So maybe you could help us understand that.
- Dr. Lieberman:
- Well, there is a connection between all three of the things you mentioned: that is, asthma, rhinitis, and reflux. Let me start first with the connection between rhinitis – inflammation of the nose – and asthma, a peculiar form of inflammation of the bronchial tissue in the lungs.
The nose can be considered the guardian of the lungs. The function of the nose is to filter, moisten, and warm the air we breathe in preparation for that air [to] enter the lungs. So whenever you have a condition affecting the nose’s ability to do those three things, asthma worsens.
So we know that patients with active rhinitis, for example, have worse asthma when their rhinitis is active than they do when their rhinitis is inactive.
It’s been shown that if you treat rhinitis alone, even if you don’t treat the patient’s asthma, their asthma can get better, and vice versa. Anything that activates the rhinitis in the nose can activate the asthma, so keeping the nose symptom-free is a very important principle in taking care of the lungs. There is a very strong connection between the two.
The mechanism [that] produces that connection has been studied extensively. We don’t know for sure, but we do know that more than likely it’s a reflex. That is, if you irritate the nose, it sends a message to the brain. That message is then translated and returns not only to the nose, but to the lungs.
When the brain gets the message, it knows it’s coming from the respiratory tract, but it isn’t quite sure where. It then causes the lungs (not only the nose) to weep, and the bronchial muscles to constrict.
Now, how does gastroesophageal reflux enter into that picture? The same mechanism – a reflex produced by the reflux is probably accountable for worsening [both] the nose [and] the lungs.
For example, people who have heartburn, regardless of whether the acid from the stomach appears only in the lower or the upper esophagus, regardless of the location of that acid, will have worsened symptoms of rhinitis.
Therefore, acid in the esophagus makes the nose worse, probably through the reflex, and it also can make the lungs worse.
- Andrew:
- So, are you saying that treating nasal secretions and the top of our respiratory system could help someone with asthma – and if an adult had heartburn or a reflux condition, that taking care of that might also help their asthma and their sinuses and nose?
- Dr. Lieberman:
- That’s exactly what I meant, and the flip side of that coin is also important. Namely, if you don’t take care of those things, the asthma and the rhinitis are worsened. So someone who has asthma needs to investigate whether or not they [also] have rhinitis – whether or not they’re having heartburn – and they should discuss it with their physician.
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The link is stronger than you think. Did you know that around 60%of people with asthma also have gastro esophageal reflux? This is compared to 10% of general people !