The asthma you’ve been treated for may not be asthma after all. Acid reflux has recently been discovered to be the cause of a number of misdiagnosed respiratory ailments, including laryngopharyngeal reflux (LPR), which mimics asthma, when the patient experiences "silent reflux" and doesn't present with chest pain or heartburn as a telltale sign.
Saint Joseph, MI otolaryngologist Dr. Dennis Thompson says that gastroenterology literature going back some 30 or 40 years often took note of people with heartburn having voice or throat problems but adds, “unfortunately, the information didn’t take hold very much with ENT physicians or gastroenterologists until recently."
While beneficial to digestion, stomach acid can irritate, destroy and scar the fragile lining of the esophagus. Left untreated the damage could lead to serious medical problems including esophageal cancer and possibly throat and voice box cancer. However, according to research conducted by Dr. Jamie Koufman of Wake Forest University Baptist Medical Center, half of all LPR sufferers deny having heartburn whatsoever; 13% had two or fewer episodes of heartburn per week and only 10% complained of more frequent heartburn.
Unfortunately, without symptoms of heartburn doctors still often overlook reflux as a cause of a number of medical problems besides LPR including:
- chronic cough and/or throat clearing
- hoarseness
- reactive airway disease (mimicking asthma symptoms)
- pauses in breathing (apnea)
- pneumonia
- bronchitis
- difficulty swallowing
- globus (a feeling of a lump in the throat)
- bad breath
LPR is caused by a backflow of food or stomach acid into the larynx (the voice box) or the pharynx (the throat) which sometimes causes the larynx to go into spasms and makes it difficult to inhale. It’s the way the voice box reacts when a person is drowning, shutting down to prevent water from being aspirated into the lungs; however, in LPR sufferers it isn’t water, but stomach acid the mechanism is trying to keep out. Unfortunately, the condition also restricts oxygen from entering the lungs.
Acid Reflux Mistaken for Asthma
Carol Collins, a St. Joseph, MI pharmaceutical sales rep, first experienced laryngopharyngeal reflux (LPR) several months after undergoing a thyroidectomy, and several more over the weeks that followed.
“I‘d wake up with a violent tickle in the back of my throat that would jolt me out of bed and all at once I’d discover that I couldn’t take in a breath. It felt as if my airway had shrunk to the size of a pea and every time I coughed to get rid of the tickle the blockage became worse. I’d gasp for air and at times I honestly thought that I was dying.”
The incidents would subside after several minutes while a shaken Carol paced the floor telling herself to calm down. Suspecting asthma as the cause, Carol’s doctor ordered an in-office peak flow meter test that determined that her lung capacity was within the normal range. At that point she was referred to Dr. Thompson.
“After several tests that measured acid in my esophagus and throat, Dr. Thompson told me that I had reflux, which, compounded by scar tissue left after my surgery, caused my larynx to spasm and my voice box to shut down. I couldn’t believe it at first. I never had heartburn and in fact always bragged that I had a ‘cast-iron stomach’ and could eat anything, but he explained that sometimes stomach acid passes too quickly through the esophagus to be felt.”
Help for Acid Reflux Sufferers
The frequency and severity of Carol’s LPR symptoms gradually lessened after she began taking a daily acid pump inhibitor, which prevents the release of acid in the stomach and intestines. For less severe cases of reflux, Dr. Thompson recommends taking an antacid to neutralize the acid in the esophagus. “And even drinking a glass of water can help wash the acid back into the stomach and dilute it.”
Other tips include raising the head of the bed by four to six inches with a wedge-shaped pillow, restricting meals to two or three hours before bedtime and staying away from foods that may trigger acid reflux in some people. Problem foods include coffee, alcohol, carbonated drinks, chocolate, peppermint, oranges, tomatoes and dairy products. Good posture is also important as slouching restricts the path between the stomach and the esophagus.
Breathing problems require thorough testing to rule out a host of known causes, but reflux should be the first one ruled out before a diagnosis of asthma or another respiratory disease is made.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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