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Asthma / GERD?

Hi everyone

I’m new to this forum and hoping that some frequent users might be able to help me. I’ve been asthmatic all my life (34yrs), well controlled apart from the odd chest infection in winter. I was changed inhaler to Fostair 4 Year’s ago. Didn’t get on too well with it at first had palpitations, congestion in nose/throat etc. I tested positive for a stomach infection called hpylori in November last year and since have had issues with breathing. I get extremely breathless after food to the point it feels like a mini asthma attack. I’ve had an endoscopy and biopsies and they’re clear. I’m going for a ph study and barium swallow, however I wonder if my fostair inhaler could be contributing to my reflux symptoms. I’m told by my consultant breathlessness isn’t a typical reflux symptom however each time I’ve gone to hospital for the breathlessness they tell me my chest is clear and my oxygen levels are good. Has anyone experienced anything similar, these attacks are taking their toll on me both physically and mentally, so any advice is much appreciated.

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Hello Ninja83, welcome to the forum,

I suffer from reflux (actually going through quite a good period at the moment, though it has been worse in the past).

In my experience reflux can certainly cause asthma type symptoms. About five years ago I ended up at my GP having had four weeks of breathing difficulties. Nothing severe, just annoying at first, but it was getting worse. My peak flow levels were relatively OK, there were, however, a couple of things that were unusual: the breathing problems always came on within 30-45 minutes of eating, and exercise such as fast walking seemed to help (unusual in a known exercise induced asthmatic).

I didn't get to see my usual GP, I saw a locum, but he noticed that I had recent history of digestive problems as well as possible gastroparesis. His suggestion was that my breathing problems were caused by reflux - the stomach acid from reflux was irritating my trachea resulting in asthma like symptoms. He put me on lansoprazole for a month - problem solved.

So in my experience reflux can cause symptoms of breathlessness.

Hope this helps:-).

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Thanks MaggieHP, my symptoms are very similar my breathlessness comes on after eating usually within 30minutes of eating. I haven’t tried exercising as my GP advised not to bend etc after eating as can make it worse. Likewise my peak flow is fine. I’ve tried lanzoprazole amongst other PPIs but effects wear off after a few weeks. Would you take your inhaler each time you had an episode like that? I’m unsure if I should or not as I know you get side effects when you use it more frequently. I’m trying to understand if the irritation from the acid that provokes these symptoms is just mimicking breathlessness or if it could result in a full blown asthma attack.

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The fact that your GP has said don't bend forward (which I would agree with) suggests to me that he/she thinks it's reflux. Bending forward/slouching/lying down within an hour or so of eating can all cause problems with reflux.

If it is reflux there are other things that can help:

1) be careful of your diet. Certain foods are known to trigger reflux issues in some people. Caffeine (and yes, I'm afraid that does include chocolate), mint, spicey or fatty foods, citrus foods, tomatoes, onions (along with garlic and leeks), and pineapple are the ones that spring to mind immediately, but others on the forum may have other suggestion.

2) be careful of your portion sizes. Too big a helping of food is more likely to cause reflux problems.

3) if you are overweight, try to lose some of it (smaller portion sizes can help with this). Being overweight puts additional pressure on the sphincter muscle at the top of the stomach making it more likely that acid will leak out.

4) don't bend over or slouch for at least an hour after eating a meal. Don't lie down or go to bed for three/four hours after finishing your evening meal

5) to help prevent reflux at night, raise the head end of your bed at least five inches to help gravity keep your stomach contents where they belong. Don't rely on pillows to keep you upright, you'll slip off them during the night.

It's difficult to know what to advise as far as using ventolin to help with a breathless episode that may be caused by reflux. I know I did use ventolin when this problem began to worsen. It helped - but not for very long. It certainly didn't sort the problem out - which is why I ended up seeing my GP. You could try to see if it does help you. In my case I also noticed the breathlessness calmed down of its own accord after about three hours (which would tie in with the stomach emptying). You might want to discuss this with your GP or Asthma nurse.

I have to confess I'm intrigued by the attitude of the consultant. Was this a specialist in respiratory medicine or a gastroenterologist?

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This is all good advice. I have just started raising my bed and it does seem to help. I have also been told to give up fizzy drinks and caffeine, including chocolate. Hopefully it helps.

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Thanks again for your reply Maggie, appreciate it. I currently do all the things listed however still experience terrible breathless episodes. I eat pretty much the same diet every day, some days I’m okay and it’s manageable, other days it’s terrible and I struggle to eat. I’ve actually dropped three dress sizes and I’m worried about losing more as now down to a size 6. The Consultant is a very experienced and sought after Gastroenterologist hence why I’ve started to question if the breathlessness could be something else based on his “expert” opinion.

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I do sympathise, I really do. I have been through weight loss - twice - and ended up clinically underweight on both occasions; it is not a pleasant experience. Like you I got to the point where I was eating something fairly similar every day. The second time it happened a definite diagnosis was made during an endoscopy (oesophagitis resulting from oesophageal thrush) but that condition did not cause me to feel breathless. It did give me horrendous heartburn, but that's a different thing altogether. The first time was more of a puzzle. I had what we think was a vomiting bug (possibly norovirus) and it left me with real problems when it came to eating. At the time it was thought gastroparesis (delayed stomach emptying) might have been to blame. The way it was described by the consultant I saw was that the ferocity of the vomiting bug might have affected the nerves of the stomach temporarily, impairing its ability to empty properly. I was put on Lansoprazole to help reduce the amount of acid resulting from that and the problem did resolve (although my stomach can still have the occasional hiccup - for want of a better word). But again, I do not recall having breathing problems during that time.

I do hope the ph study and the barium swallow come up with some answers and things improve for you. Things have got better for me over the past year and a half though I am still under the care of a consultant gastroenterologist and still require some medication to help with reflux (Gaviscon advance suspension) but my reliance on that is getting less now. There are still question marks as to why a vomiting bug has caused so many problems (I have others vomiting illnesses in my time, none of which have done that). I have wondered whether hormonal changes may have played a part - I was borderline perimenopausal at the time it started. The improvement over the past year and a half has coincided with me coming out of the menopause. But we really don't know.

Please do talk to your GP about your breathlessness and what can be done to help you with it. Do you have a peak flow metre? If so, have your peak flow readings dipped?

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Thanks Maggie. It’s interesting your symptoms came off the back of a stomach bug as mine appear to have cake off the back of the hpylori stomach infection which was left untreated for 4 months following incorrect diagnoses by my GP. I’m glad you have found some relief and now only occasionally have symptoms. My peak flow has dipped slightly but not a concern to my GP. Fingers crossed the barium swallow and ph study provides some answers and relief!

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Hello! I am going through this right now. I've been doing a lot of research and saw crazy overlap between those with asthma and reflux. I asked my doctor about it and he said that yes reflux can cause asthma symptoms because of the acid. I feel chest tightness daily and was attributing it to my chemical sensitivity, but I think the reflux has a lot to do with it. I took omeprazole for a month and it didn't help. However now I pop an occasional tums and it starts to relieve the heart burn and the chest tightness. You are right to pay more attention to the food you eat and the timing of the pain you feel. Sometimes it is food that I thought I was ok with. Even water can be an irritant. Happy to chat more

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Hi lpapajohn, sorry to hear you are experiencing similar but pleased to hear you get some relief from tums. I’ve actually paid for food allergy testing too as I was convinced I was having an allergic reaction to food at first especially given the breathlessness however they came back negative. It’s interesting your GP has advised there is a link between asthma and reflux I’m surprised my Consultant doesn’t seem to think so.

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May be wise to handle this with two approaches.

1. Treat the Asthma Symptoms.

2. Treat the Reflux at the same time.

It has taken me a year to get a diagnosis of GERD features found after an endoscopy.

How did this happen? I also got an H.Pyroli infection. And when treating it with PPIs (Lansoprazole) I noticed for nearly two months I did not need to use asthma or rhinitis medication. That led doctor to recommend an endoscopy.

My Lower Esophageal Sphincter was found to have issues.

So, the choking feeling or discomfort after meals and intermittent breathing issues yet you have normal peak flow, is likely to be due to irritation from refluxate.

Also- take note of what the feeling of breathlessness really is. Sometimes it could be a spasm of the esophagus itself or closing off by the upper sphincter to hold of the reflux hence giving that choking feeling or discomfort yet you can actually breath.

It can be scary but if you remain calm, it can pass in 10-30mins depending on severity.

Not everybody responds to PPIs. That is the issue you may be having. Try other alternatives and see. Am sure your doctor will advise.

Follow the advise someone gave: smaller portion meals, avoid reflux causing meals like oily foods, no bed until at least 3hours after a meal etc.

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Hi DotPro, thanks for the advice that’s what I’m doing at the moment however worrying I may be taking my inhaler more unnecessarily if it just the reflux. I also think that my symptoms are GERD and possibly to do with the LES not working properly, hence why PPIs aren’t helping much. I’ve been doing mindfulness to try stay calm when an episode comes on, hopefully I’ll get your bottom of it soon.

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If you are having breathing problems, treat the breathing problems until they are out of the way.

You need to breath, we all do. It is about life.

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Hey there,

Sorry to hear you are unwell.

H. Pylori often cause gastritis, which can leave you with a feeling of breathlessness, but the truth is you are having stomach cramps. Your stomach sits pretty high up in your abdomen, so stomach pain can get confused with chest pain and it can cause you to feel out of breath. Gastritis can also be caused by too much stomach acid. Maybe try taking antacids for a few days and see if your symptoms improve.

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Thanks Cherry, hopefully further tests will help get to the bottom of this.

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