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Column originally published Jul 23, 2002

Reflux (GERD) Is An Uncommon Cause Of Asthma In Children

Question: Our son is five years old. He was diagnosed with asthma by our paediatrician since infancy. We have made a lot of changes in our house. In the past year, his asthma would flare up during fall and winter, mostly with colds. In between, he is very healthy, and have no sign of cough or trouble breathing. He only takes his asthma medicine when he gets sick. Lately a friend told us that asthma can be caused by reflux, and asked us to get him tested. We are a little confused. Is it necessary to do more tests on our son at this time?


Your question about the relationship between asthma and reflux is of interest to many parents who have children with asthma. Let me first explain briefly about the common triggers of asthma, and then discuss your concern regarding reflux.

As you probably know, the most common triggers for asthma in young children are present in the indoor environment (at home or in school). These include dust, mildew, animal dander, cigarette smoke, as well as chemical irritants. In many young children, viral infections frequently trigger attacks of asthma.

Most of these triggers affect children during fall and winter. At these times children spend much more of their time indoors. Our newer air-tight homes tend to keep these triggers circulating around more than in older leaky houses. Forced-air heating present in many homes also increases the circulation of these triggers throughout the house.

Viral infections that can trigger asthma attacks are also more frequent during fall and winter. Viruses have a better chance of spreading when children stay close together, in schools or in day-care settings. Older children attending school also can bring germs home to their younger siblings.

Many parents would have similar experience like yourself. Their children are mostly healthy during the summer. When fall starts, especially when their children get the first cold, the symptoms of asthma starts. These can include coughing, chest congestion, wheezing, and shortness of breath, especially during exercise.

If the indoor environment is not affecting the child’s lungs, asthma symptoms can improve completely after the cold is over. There may be no asthma symptom until the next cold starts. There will be no need for asthma medicine except during colds.

However, many children continue to have some asthma symptoms like daily cough, especially when they are active. Some children may even cough when they laugh or cry. This is likely due to the presence of triggers inside the home. These children would need some preventative asthma medicine to keep their bronchial tubes healthy. The amount of preventative medicine required is usually very small.

Let me explain a little about what is reflux. The full name of this condition is gastro-esophageal reflux disorder (GERD). Food normally passes from the back of the throat through a tube like structure called esophagus into the stomach. At the junction with the stomach, there is a muscle that controls the entry of food into the stomach, and prevents it from going backwards.

In some children (as well as in adults), this muscle is weakened; food can travel up and down in both directions. If stomach juice or food goes up to the back of the throat, there is a chance that it can be aspirated into the windpipe, giving rise to coughing, chest congestion, and sometimes wheezing.

How often does reflux occur, and how likely it causes asthma symptoms? There is no uniform opinion among specialists who work with these children. We know it exists. Some children with difficult asthma problems improve when their reflux is treated.

On the other hand, all paediatricians have seen young children who have reflux and spit up all the time, but they do not develop any chest symptom that would suggest asthma. Therefore, having reflux does not necessary lead to asthma.

If reflux is the cause of asthma problem, one would expect asthma symptoms to occur quite often, might even be daily. Since your child only have intermittent asthma problem, mostly associated with colds, it is unlikely that reflux is the cause of his problem.

However, if a child has daily asthma problem which is hard to control, one should look for other medical conditions, and reflux is just one of them. Tests for reflux involve some degree of radiation. Unless there is a reasonable degree of suspicion, I generally would discourage parents pursuing these tests just to check everything out.

I hope the explanation that I provided here answered your concern regarding reflux. If your son continues to do well and is perfectly healthy in between colds, my guess is that he doesn’t have reflux, and it would be a waste of time (and radiation) to subject him to additional tests.