Silent reflux or asthma?: I'm... - Asthma UK communi...

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Silent reflux or asthma?

AirIsUnderrated
AirIsUnderrated

I'm undiagnosed - now 3 months post-suspected-Covid, still with laboured breathing, and an "itchy" and often sore chest especially on the right side. I've had 2 chest infections. Most days I'm pretty good in the mornings, then it gets tight after lunch and progressively worse until after dinner. Night times and lying down are generally fine.

I've been on salbutamol as required for 9 weeks and Qvar 50 (beclometasone) for 5 weeks. I tried 10 days of desloratadine antihistamine which felt great for the first 3 days then worse again. Chest x-ray was clear. Covid antigen test at week 10, and antibody test, bloods and eosinophils at week 11 were all negative/normal.

I rang my GP to find out about renewing or stopping the Qvar but also to say that this isn't changing. He said to carry on the same until I "bore it" and it goes away. He said he's got a lot of patients reporting the same thing, dismissed the desloratadine, rejected my revisit of the reflux suggestion, renewed the Qvar and that was it - 10 minutes.

Maybe he's right and I just have to continue to be patient, but I can't help over-thinking it. I've had 11 phone consults since this started, no examinations (I get it - they can't) and I don't feel much further forward. Nobody has listened to my chest and heard the wheeze, or checked for a hiatal hernia. What if this was silent reflux all along? Is it dangerous to leave it untreated? I have an occasional cough, definitely not persistent. No heartburn, bad taste, burning, hoarse voice, nausea or vomiting. I sleep on my left and the soreness is on the right. Maybe it isn't.

Ugh. I'm sorry, I'm rambling. And fed up!

28 Replies
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Just to offer you some condolences, I too am without a diagnosis and I have been for 18 month! I've had 4 x-rays, a CT scan, pulmonary function test, 3 different steroid inhalers and still no further forward. If anything my symptoms feel like they are getting worse.

My x-rays we're all normal

My PFT were suggestive of obstruction with questionable reversibility (9% and 400ml)

My CT said early bronchiectasis but have since had 2 other radiologists and my consultant disagree with this (clinically, I've only had 1 bacterial chest infection ever, and no history of lung problems as a child)

My symptoms started with a wheeze when I exhaled with slight force, after I had a 2-3 month long chest infection Xmas 2018, ventolin helped with that. Over the last year I developed a bit of breathless when I walk short distances, but what's weird is if I keep walking for long distances, I improve.

I don't seem responsive to steroids, I've been on them 6-7 month now. I'm now on a LABA and only really benefit from the bronchodilator bit of it.

Covid pandemic has not helped as I've had my consultation cancelled. I've now been referred for a methacholine challenge test and an ENT appointment. I probs won't have those for months given the current climate.

It's an absolute chew!

I'm so sorry, and worried that I might be posting a similar thing in another year. Has anyone suggested acid reflux to you? There seems to be a correlation between breathing trouble and reflux, although nobody seems to be sure which is the cause. Reflux can get into lungs and irritate them causing a wheeze and even pneumonia. Conversely people with asthma are prone to reflux, possibly because the diaphragm is having to work extra hard to inflate the lungs putting extra pressure on the organs beneath. I'm speculating here though.

Have you ever stopped the steroid inhalers to see what happens?

I've thought about some sort of reflux, but I don't really have any classical symptoms of it, however I am being referred to ENT so they might be able to have a look around there for irritation. Most of my irritation is my lower throat, below vocal cords, in between clavicles.

I want to stop the steroids but I feel if I do that I might be delaying the "next steps" of what ever my consultant wants to do next, so I'm just being a good boy and doing as I'm told at the minute.

I'm sure you won't be left as long as me, I'm just a strange case according to my resp consultant.

You could try Gaviscon regularly (think it's 4 times a day) for a couple of weeks to see if things improve - if it does then silent reflux might be a possibility and, if it doesn't, at least you've got that reassurance. I think the liquid is supposed to be better than the chewable tablets but have not tried either myself. This is all while staying on your current meds.

Thank you!

Yes, I started on Peptac liquid this evening after dinner. Revolting stuff! I was thinking of 3 times a day after breakfast, lunch and dinner, as I have no night-time issues and don't snack after dinner. Wouldn't the salty water I'm swallowing constantly be acidic, or even minty if it was coming from the stomach? It feels as if it's coming from my lungs. Or maybe it's from my lungs but caused by acid?

Hi I have had similar to you have been suffering since last September and have progressively got worse and been using my inhaler lots and on salbutamol and fostair. Have also had a chest infection. Had 2 Covid swabs which were negative, having antibodies test next week. I have suffered reflux in the past but wasn’t getting the burning sensation, anyway started back on omprezole twice a day and it improved my coughing almost instantly! Am still not great think it I have a combination of things causing me to cough including post nasal drip and allergies, have had to cut right back on dairy products. But silent reflux was definitely causing me to cough, wheeze and have lots of mucus building up. Reflux was probably silent due to the damage the acid has done to my throat etc.

No harm in your gp trying you on omprezole or something.

Don't take Peptac - it has to be Gaviscon Advanced. I have silent reflux and asthma and it is sometimes difficult to tell them apart, because the symptoms are similar - unlike tradition 'GERD' reflux, there's no heartburn, bloating etc.

I'm awaiting a consultant appointment to assess the damage to my larynx. In the meantime I was referred to a speech and voice therapist who told me there is an ongoing dispute between her profession and GPs. Only Gaviscon Advance effectively creates the protective layer needed for silent reflux but Peptac is much cheaper, so GPs prescribe it to those who qualify for free prescriptions.

My GP wouldn't prescribe it at all, so I bought it. I pay for my prescriptions and Peptac is cheaper than the £9.15 script charge. I have never heard of Gaviscon Advanced. So Peptac won't help, for certain? It's so vile! How long might I have to take it before I know either way - any idea?

I'm wary of starting Omeprazole because of the risk of rebound reflux if it doesn't help. I've read that the dose starts at a month's supply, and that's how long you have to be on it for rebound to happen. I'm one of those awkward people who tends to get side effects more than the effects.

My therapist was adamant that Gav Advance, not the regular one, is the only one that will work. It is expensive - I buy mine, because although I am 60 and qualify for free prescriptions, the GP is only able to prescribe Peptac - NHS rules.

One thing you may not know is that you can ask for the 500ml bottle, which works out a lot cheaper. You have to ask for it specially at the pharmacy counter. It doesn't taste much better then Peptac, to be honest, but comes in peppermint or aniseed flavour.

Emaych61
Emaych61
in reply to Freesi

I think it must depend on where you live because I’m on gaviscon advance (have been for nearly six years) and I’ve always had it prescribed by my GP. When I was in hospital (not asthma related) I was given Peptac instead - and found it revolting. The colour alone should have warned me it would be bad - poisonous pink or what.

Haha! My Peptac is white, but is really difficult to get down without gagging. I don't mind the flavour, but it's like swallowing one great long string of slimy seaweed. It just won't go down!

I got rebound when I came off lanzoprazole (another PPI - I didn’t get on with omeprazole) though I know of a number of people who don’t have that problem.

When I started to have problems again with silent reflux seven or so months ago my consultant put me on cimetidine instead. First time round this worked like a charm, but the problem recurred two to three months after I finished the 30 day course and the symptoms were more severe. It took more than one course to bring it under control and I’m still on it now though I am now reducing the dose (no rebound symptoms - thank goodness).

Thank you. That gives me a little ray of hope. I'm on day 2 of Peptac now. A cough is developing. Interesting.

Having re-read your original post the one thing that does make me wonder whether it is silent reflux is the fact that you don’t have a problem with lying down. The head end of my bed is raised (originally five inches but I had to increase that to six during this last flare up) to help gravity keep things where they should be and that is not unusual for reflux. As I said originally, and others have also suggested, if it is reflux it should respond to gaviscon advance. If it doesn’t something else may be going on. Either way ideally you need to be seen by a specialist to sort it out.

That's the one thing that jumped out at me too. I wondered whether that might be the "silent" part? Haha!

The “silent” part refers to the fact that the usual symptoms of reflux (heartburn etc) aren’t there. Breathless and coughing are more common instead.

I am in a similar situation! I’ve been struggling with my asthma since the start of April, having never had an issue with it before. I also suffer from silent reflux and a sliding hiatal hernia has been mentioned in the past but I’ve never had any tests to confirm this. I’m on omeprazole morning and night and take gaviscon 4 times a day. I do find this helps but it has not solved the issue. I would definitely recommend trying this

I get a sore, tight feeling in my chest and I don’t know if it’s my trachea or esophagus. I am always hoarse and find it difficult to swallow at times. I don’t find my asthma medication helps much which leads me to think it might be reflux related! But I really don’t know! Like you I’ve had over 10 phone consultations and am yet to see a dr.

Sorry to hear you’re having problems and I completely sympathise. I suffer from both asthma and reflux/silent reflux (confirmed diagnosis of of both conditions): persistent asthma I’ve had pretty much all my life; the reflux began ten years or so ago and comes and goes.

It can be very difficult to distinguish between the two, even for a GP. With me the dead give away is how I am after eating and drinking: if it’s silent reflux I’ll know about it within half an hour or so. I’m currently under consultant led care because my GI tract is problematic, so the GPs are aware that any breathlessness or persistent coughing problems could be down to either one of the two and these days they do listen to my point of view. Currently I’m just getting over a bad flare-up of silent reflux (consultant has requested a gastroscopy but because of covid it could be months before it gets done), and with me it was breathing issues (iron bands round chest feeling) and coughing - a mostly (though not always) loose and productive cough.

With me the final clincher as to which it was this time round (other than the timing) is what it responded to. Ventolin just didn’t work, whereas taking a spoonful of gaviscon advance suspension liquid brought on some relief. I note someone else has recommended gaviscon. Gaviscon advance is the best one of the group (I think you can get that over the counter) and the liquid form is more effective than the tablets. I also found that getting up and walking round was more helpful that sitting down (gravity at work and less pressure on the stomach and the sphincter muscle at the top of it if you’re standing up).

Hope some of this is of use and that things get sorted soon.

Thank you, that's really helpful. Poor you.

For me the itchiness in my chest is there when I wake up. It gets worse as the day progresses, and the soreness starts around lunchtime, sometimes before, sometimes after. It gets worse throughout the afternoon and I often need salbutamol in the afternoons and evenings. If I don't, before or after dinner my breathing often gets laboured and I start coughing. That is definitely worse after eating, because it feels as if there isn't space for the air and food at the same time while I'm sitting on the sofa. Standing up and walking around, and leaning on the window sill helps. Lying flat or on my stomach helps. It all goes away except for the itchiness when I go to bed. Only when I had the chest infections did I have breathing trouble lying down.

Does all that sound like silent reflux?

The itchiness doesn’t. I get that (and have always got that) during an asthma flare. It’s maddening. I really, really wish I could get at it and I can’t. I end up rubbing at my chest in vain.

On the other hand finding that standing up and moving round/leaning on the sill sounds very familiar and I’ve found myself doing both in the past few months.

As I said, really your best hope is to get a referral, though goodness how long it will take for you to be seen. I know I’m on a waiting list for a gastroscopy, but I’ve been warned it could by “some time” before it happens. The way things are going by the time I’m seen everything will have calmed down to such an extent I’m not convinced they’ll find anything. Missed opportunity. I understand why completely, but it is very, very frustrating.

Very, very frustrating.

The itching - you feel like poking a knitting needle down there and giving it a good scratch, don't you? Rubbing the outside just doesn't cut it. Haha!

I've also missed every opportunity so far: I started this before Covid testing was released. They started recommending Doxycycline the day after I my first chest infection started, so I had symptoms for a week before I was given it. Couldn't get in for the chest x-ray until just after the antibiotics for the second infection had finished, so naturally it was clear. I didn't get the antibody test until week 11 so that was negative as well. Of course it could have been negative anyway. We'll never know now.

The itching and a wheeze (I might have forgotten to mention that I have an impressive bubbly squeak on exhaling) were the very first symptoms of all this, way back in February, long before the breathlessness and fever started at the end of March. Other than a chest infection 5 years ago which I recovered from fine, I haven't had chest issues since I was an allergic child living with a smoking father. All that cleared up within weeks of moving out, and never came back. But maybe this IS adult asthma.

I spoke to a lovely pharmacist today when I picked up my script, and he said to keep pestering the doctors. I'm pretty sure I need to get an examination before I can get a referral.

Ah well. It can't be much longer before they open up to non-shielding patients. And I know the hospitals are working through the "non-urgent" referrals now, so fingers crossed for you.

I too have asthma and it has been suggested by GP that I have silent reflux I also have constant thrush in my throat and gullet so take fluconazole capsule 200mg every other day to control it I take Pulmicort 100mg 3 puffs twice daily I have tried other steroid inhalers but I feel they are all much the same, they all give you a hoarse voice and can cause thrush despite rinsing and gargling thoroughly Pulmicort is a dry powder inhaler so using a spacer is impossible but to be frank they don’t really help. I have found the best way to find out if it’s reflux is to use Gaviscon Advance or Nexium (esomeprazole) both available on line from Amazon your GP will of course prescribe the proton pump inhibitor but won’t give you Gaviscon Advance which is miles better than the ordinary Gaviscon. I never had reflux ,thrush or a dry mouth until I was started on the steroid inhalers so I conclude that they are side effects of the steroids. Thrush can cause the sore feeling in your gullet and trachea as can asmtha and reflux. I have tried to limit food triggers for reflux coffee, spicy foods, fried foods ,high fat food etc, have tried cutting down my Pulmicort but my conclusion is that if you have asthma you have no choice you need the inhaler to control the condition which could kill you so you just have to put up with and manage the side effects of the medication. Hope my experience helps, try not to overthink things I’ve found that relaxing and doing something enjoyable helps tremendously stress makes asmtha worse. Warm wishes Liz

Emaych61
Emaych61
in reply to Lizziep25

Lizziep25, not sure where you are but I do get gaviscon advance on prescription. Now granted I’m under consultant led care for gastric issues, but I’ve had gaviscon advance on prescription for a number of years. Even when things are good (not the case at the moment) I usually need a teaspoon of the stuff before going to bed

Emaych61
Emaych61
in reply to Lizziep25

Interesting also what you stay about steroid inhalers being a possible cause. Of thrush, yes - though some people on steroid inhalers seem to be more susceptible to it than others and I’m not sure they understand why yet. I’ve never had oral thrush, though I have had the much more unusual oesophageal thrush which the consultant I was seeing at the time put down to my inhalers (dry powder version of Flixotide 250). That argument really fell flat though given there was no evidence of oral and pharyngeal thrush, which is a more usual symptom, and I’d been on steroid inhalers for over twenty years without any problems at all (and ten of those were on the dry powder variety).

In my case we think the reflux issues are down to a combination of factors, the first being that I have a collagen which is a little too elastic (resulting from a genetic mutation) and various parts of my body have been affected by it (hypermobility, flacid bowel, etc). The reflux issues also really kicked off when I entered the peri menopausal stage; the hormonal swings relating to that certainly won’t have helped any issues resulting from stretchy collagen.

There are other things that can increase the risk of reflux: being overweight, smoking, anxiety and stress, hiatus hernia etc., so it need not be down to inhalers at all:-).

Freesi
Freesi
in reply to Lizziep25

As soon as you have used your inhaler, rinse your mouth and gargle (cold water). Itbreally helps to keep the thrush down - I wish my GP had told me this a long time ago.

All I can tell you is thst in the USA, people are reporting lingering symptoms occasionally for months after having COVID. Can you get a second opinion?

Thank you! Yes you're so right. I'm reading more and more articles saying the same thing. And none of the doctors know what to do other than treat symptoms. This is all new.

I've spoken to 5 different GPs in the same practice about this now. Most have given me a generous amount of time, but there are so many questions that I only think of afterwards. They all listen to me then reply "what do YOU think? What would YOU like to do?" which is a little unfair as I'm not the medic. The only polite thing to say is "I'm the patient, you're the doctor, I'll do what you suggest". I've already told them my story, what I've tried and my reservations.

I've spent hours on the internet reading up on all this. It boils down to any/more than one of:

- gastric, (silent reflux? hiatal hernia?) which needs a physical examination that they can't do because they haven't opened the surgeries up to non-shielding patients like me yet

- asthma, which needs spirometry etc. tests which they also can't do for the same reasons

- allergy, but antihistamine didn't help

- anxiety, which I'm waiting for someone to suggest next simply because I keep banging on about it

- protracted post-viral (Covid? other virus?) symptoms that can only be treated while we're waiting for them to go away - that's what they're going with. And maybe it is. But it's not flipping going away! What if I'm faffing around with inhalers, antihistamines and extended patience if it's tuberculosis? (I don't think it's tuberculosis!)

I believe that they genuinely have nothing left to suggest. My only way of getting another opinion would be to change practice after 25 years, and I really don't believe anybody else is going to have anything new to offer.

Please forgive me. I don't mean to be negative or knock your suggestions back, and I very much appreciate your input. It's just... I don't know...

Thank you for all your responses, everyone.

I decided to start by taking the Peptac I already had. I've been taking it for 6 days now, 4 doses a day, 1 after each meal and 1 before bed. I have noticed no improvement whatsoever, and yesterday I actually had heartburn for the first time 🙄. How unpleasant!

My chest it still itchy all the time I'm awake, and it gets sore and my breathing is more laboured as the day progresses. I'm coughing sporadically, although coughing doesn't help the itch and only makes it more sore so I'm trying not to. Yesterday evening I felt as if I was trying to breathe through a straw.

Does this suggest that I'm barking up the wrong tree, or is it worth upgrading to Gaviscon Advance once I've finished this Peptac bottle?

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