Between all existing types of asthma, reflux-induced asthma is a well-known and documented form that has a high impact on people’s lives.
“It is a disheartening situation. This is one of the most expensive forms of asthma, not only in terms of money but also and more importantly in terms of quality of life of patients, who are forced to delay treatment and live with their illness for long periods, while going through changes of specialists and therapies and assuming many medicines before having the correct diagnosis” said Prof. Dal Negro.
This pathology comes from disorders of the digestive tract, in particular from gastro-pharyngo-laryngeal reflux disease, and it is often associated with respiratory manifestations that can mislead the physician and be mistaken for other asthma types.
“Such diagnostic mistakes turn into a long and not always effective diagnostic and therapeutic journey for a patient” concludes Prof. Dal Negro.
Reflux-induced asthma means that gastric acid backing up from stomach into the esophagus induces asthmatic attacks. In sensitive patients, such condition activates the autonomic vagal nervous system (parasympathetic ) through a reflex pathway and this will indirectly trigger a bronchospasm by the chemical stimulation of gastric acid of this neural pathway.
This can also increase bronchial hyperresponsiveness in asthmatic patients. In other cases, little quantities of gastric acid are suctioned into the bronchial tree and the upper airways, thus triggering asthma attacks and even causing aspiration pneumonia (so-called because of aspiration of gastric content into the bronchial tree). It has also been related to bronchiectasis and pulmonary fibrosis.
Various studies have proved that up to 80% of asthma patients present gastro-esophageal reflux, as shown through esophageal-gastric endoscopy or esophageal pH monitoring, and such condition can induce asthma attacks in some subjects.
This should make us consider with attention the presence of gastro-esophageal reflux in asthma patients, especially in those who have a weak response to anti-asthmatic therapy. Moreover, some anti-asthmatic treatments can occasionally augment the secretion of gastric acid; for instance, it’s the case of methylxanthine drugs, such as theophylline, a bronchodilator sometimes prescribed for asthma patients. In addition, some features should increase our index of suspicion for this pathogenesis of asthma: onset in adulthood, occurrence of cough, worsening with food, improvement with antisecretory therapy.
Correct methodologies and greater awareness of physicians to the pathology can avoid costly mistakes and afford those affected a better quality life.
Trabucco method appears to be one of the suitable methodologies to treat asthma from gastro-pharyngo-laryngeal reflux.