I’ve spent 4 days in hospital this week with para influenza making my severe asthma bad. Doctors also think silent acid reflux is also irritating my lungs and making things worse.
My breathing is back under control but I’ve an awful chesty sounding cough particularly at night which eases when I sit right up. I’m on lanzoperazole 30mg twice daily as well as preds and my usual asthma drugs which include Xolair.
I’m really struggling to know what to do with this problem. Getting very little sleep and feeling quite unwell.
Any suggestions?
Kath
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Bwv945
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I have asthma and acid reflux and have a nasty cough for 5 years.symptoms of acid reflux is a cough as I learned lately.well hope your cough does not last that long
GERD or reflux is a common thing with asthmatics and it be a trigger for asthma symptoms. Taking prescribed meds for it long term doesn't come without risk. This explanation, options available and suggestions on how to minimise GERD is very useful: asthmaandallergies.org/asth...
I’m in the process of tapering off my medication for acid reflux (cimetidine) after 24hr pH monitoring revealed that the levels of stomach acid going into my oesophagus was on the low side of normal; this despite the fact that I had to come off any acid suppressants a week before the test in order to allow things to normalise. The annoying thing is that by the time I got the test (requested by the consultant 8 months earlier) I knew things had calmed down so I wasn’t entirely surprised at the result. Reflux has not been ruled out though; there is such a thing as non acid reflux which can also result in breathing issues.
I’m now having to cope with the rebound effect from weaning off medication to suppress stomach acid which I have been on for fifteen months.
Trouble is, low stomach acid can result in the sphincter to work less well, allowing stomach acid to escape into the oesophagus. Being too alkaline can cause reflux so by using antacids we are making the problem worse. But testing the PH levels first, before starting meds would be ideal. I know my GERD is the result of a hiatus hernia. I was lucky enough to get tests before anything was prescribed. Now I find that by altering what I eat, and when, has really helped. But that's just my experience and trying to get to the bottom of why GERD starts in the first place is best in the long run. We need sufficient acid levels in the stomach to digest protein and to avoid other digestive problems.
The health of the stomach is more important than previously recognised and I feel we're still playing catch up.
It does seem very complicated, I’m quite unwell at the moment and have just spent a few days in hospital.Out of interest what have you done with your diet?
It does sound like the reflux is causing you a miserable time. I now only eat twice a day and well before bedtime so that the digestive system isn't working all the time. I avoid processed/refined foods/sugar and never drink alcohol or coffee. My diet is geared towards omega 3 and I avoid omega 6 as, for me, it's inflammatory. A decent amount of veg and some fruit, protein and very few carbs. It's all trial and error to see after each meal how the reflux is. Whether it's amounts eaten or a particular food, over time I've more or less figured out what suits me. But two meals a day may not suit everyone and skipping meals can aggravate reflux for some. It's definitely a personal journey, discovering the root causes and triggers.
I admit to feeling rather frustrated about the lack of testing when I first warned my consultant that the reflux had flared (completely out of the blue) back in early December 2019. Despite eleven years of issues on and off he decided to put me on cimetidine (knowing that I get bad rebound from PPIs) and said that he would request a gastroscopy if things didn’t settle. I thought at the time (and said as much to my husband) that not requesting the usual tests for reflux at the time was a missed opportunity. By the time it was clear the cimetidine had not worked covid was upon us and outpatient appointments were being cancelled, including mine. Result: apparently a year plus of inappropriate treatment. I was supposed to be having a consultation in April 2020 - even that went (my GP was not happy when she heard about that). When things got worse she contacted him and he requested a gastroscopy - which showed no signs of acid reflux when it occurred in September of last year. No surprises there: non acid reflux returns normal results from gastroscopy. I now have a different consultant (someone who came out of retirement to help clear the backlog of cases resulting from the first wave of covid and was handed all those who conditions could be managed “at distance” apparently). His area of interest is not upper GI, it’s the liver, but give him his due he requested the right tests even though I had to wait for them.
I’ve been being careful with my diet for thirteen years now, and I can usually go months, even years, with few issues just by taking Gaviscon advance, watching what I eat and having the head end of my bed raised five inches. Lack of contact with the original consultant and then being switched to someone else (without being told: first I knew of it was when I got a letter saying my next appointment was going to be with a doctor I’d never heard of) has left me on medication I shouldn’t have been left on. No wonder things were gradually getting worse (head end of bed was up to 7 inches high when the ph monitoring occurred).
Blimy sounds like you have had a rough time. They seem to be calling mine silent reflux. No acid feeling but a kind of lump in the throat, difficulty swallowing and horse ness all far worse than they actually sound.I was discharged from hospital yesterday after picking up parainfluenza and my asthma getting very bad, one of the doctors also though reflux was making the symptoms worse. When I lie down even propped up I have the most appalling chesty cough. Does any of this sound familiar to you? What symptoms did raising the bed help with and what diet changes have you made?
Silent reflux is the name given to reflux symptoms (such as breathlessness, coughing, hoarseness, lump in throat) when it is not accompanied by the more usual symptoms of heartburn and indigestion. It’s the type of reflux which can be very easily confused with asthma, particularly if it’s causing coughing and breathing issues. I’ve been caught out by it more than once, thinking my asthma is playing up and then wondering why my peak flow and oxygen sats are fine and why it is that ventolin doesn’t seem to be very effective. Usually taking a teaspoon of Gaviscon Advance is enough to tell me what it is. With me, that stuff is as good at turning off discomfort from reflux (until I next eat or drink something) as ventolin is at calming down asthma.
The idea of raising the head of the bed (usually four to six inches though as I said above I have had it higher than that) is that it helps to keep the contents of the stomach where they belong - in the stomach; gravity is a wonderful thing:-). With me I usually start having breathing problems if the head end of the bed isn’t raised high enough (it feels very like an asthma attack). I usually find that lying on my left side can help to ease things down if the cause is reflux. Apparently the way the oesophagus links to the stomach usually means that lying on the left side again can help with keeping stomach contents where they should be (conversely lying on the right side can aggravate things). The only time this doesn’t work in my experience is if the head end of the bed just isn’t raised high enough to help or, of course, if the cause of the breathlessness is actually asthma.
Diet: the triggers can vary from person to person, but certain foods are known to be very common triggers: caffeine (sorry, that includes chocolate), tea, red wine, citrus fruits, mint, onions (and garlic), spicy food, fatty food, and tomatoes. I find I also have to be careful with cherries, blackcurrants, plums, peaches (unless they are very ripe and sweet) and grapes (black grapes are better than green or red, but usually one bite will tell me if a grape is likely to cause issues). Basically it’s any fruit that might be acidic (which is a right nuisance when it comes to vitamin C because most fruit which is rich in it is acidic; ascorbic acid is vitamin C). Keeping a food diary can help to isolate which foods are likely to cause you problems, but inevitably there is an element of trial and error.
Hope some of this helps and that you can get things sorted out.
One other thing I forgot to mention - I notice you mentioned having a feeling of a lump in your throat. That really does need to be checked out. I’d never had that before until the latter half of last year when I began to get it occasionally. In my case if felt as though something was applying pressure to my voice box - really unpleasant. When it became persistent earlier this year I mentioned it to my GP and she did an urgent referral to an ENT specialist. I was seen within a couple of weeks. Silent reflux can cause problems with the larynx; inflammation, polyps etc, and those do need to be addressed. So I really do recommend that you talk to your GP about that and get a referral.
I edited my reply - sorry. With me it felt as though it was my voice box that was having pressure applied to it (really unpleasant), but whatever it is, any feeling of a lump needs to be investigated.
I really feel for you. My asthma is moderate and well controlled but I know how awful I feel when a viral infection fires off my asthma and it is horrendous!! To have reflux on top …
After working in endoscopy for ten years I know, lying in bed propped up with pillows can aggravate reflux as your putting pressure on your stomach and pushing stomach contents higher up your body. It is definitely better to raise the head of the bed, I have what are called elephant feet bed raisers on my bed, only down side is feel like I'm sliding down the bed at times. Hope you get on top of your symptoms.
Thank you so much. It’s extreme at the moment. I’m on lanzoperazole30 my twice daily. Unable to lean back at the moment without coughing furiously. I’m hoping it will start to settle soon.I have ordered a wedge pillow raiser though
I’ve had bad asthma also and know that being in the hospital with it can be extra stress.( which can cause worse asthma) tried many medication.for me an inhaled cortico was best again everyone is a little different.I also deal with blood sugar issues so I eat smaller meals frequently which also helped with many different flare up.
I would suggest talking with your allergist or primary doctor about lowering or switching the Xolair.some people get or worsened acid reflux with this med.maybe just take a break and go back later.this also can identify a cause.Many people with asthma can be triggered with acid reflux or the other way around even without the medication.
I want to emphasize low doses of anything if possible.as I told my allergist,I can always increase later but once I’m on a high dose of something I can’t take it back if I have a reaction.....Don’t know if u have allergies? If so be cautious approach to things.
Through experience with moderate to severe asthma and allergies
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