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Old 02-21-2006, 09:39 AM   #1
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Aspiration with acid reflux

I recently had a lot of wheezing and tightness in my chest. My doctor swears that it was aspiration from my acid reflux. It feels like a chest cold however I do not have any nasal or head congestion. I have a horrible croupy sounding, unproductive cough. He put me on a steriod for 5 or 6 days along with Muscinex expectorant. I asked him to put me on an antibiotic but he refused. Does anyone else ever get acid reflux aspiration and how was it treated for you? Thank you~

 
Old 02-21-2006, 04:37 PM   #2
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Re: Aspiration with acid reflux

Acid reflux aspiration is typically associated with the acid reflux form called LPR (larngeal pharyngeal reflux) - it's different than GERD because the acid goes into the throat (with GERD it usually stays in the esophagous).

It is very strange that your doctor was able to diagnose reflux, but he didn't even give you a sample of reflux medication? Instead he put you on asthma medications? If it is reflux, you have several options:

1. Proton Pump Inhibitors (PPIs)
These are drugs that shut down most of the acid production in your stomach, so less acid can rise up and out of it. They can be very very effective in treating your condition. Only Prilosec is sold over-the counter, and you could try that. However, there are several prescription PPIs, including Nexium, Prevacid, Aciphex and Protonix. Nexium is made by Astrazenca, the pharma company that also invented Prilosec. But when the Prilosec patent expired and Prilosec went OTC, they debuted Nexium, which is very very similar to Prilosec, but is slightly different. My bias leans towards Nexium as I've tried all the others except for Aciphex, and only Nexium has worked. Not only did it work, it worked perfectly. This is important - if one dose of a PPI doesn't work for you, you may need to take 2 doses together. 2 doses is a standard treatment for LPR sufferers who don't respond to 1. Most GERD sufferers suffice with 1 PPI. This isn't true for every last one of us - but I take 2 Nexium every day, and I don't have asthma symptoms or the cough anymore. Please note that all these PPIs are only effective between 12 and 17 hours of taking them. If you sleep very little, you may need another dose at the end of the day or before you go to bed.

2. H-2 Inhibitors
This is the acid reflux medication group that was invented prior to PPIs. They are now all sold OTC under brand names like Tagamet, Zantac, etc. The generic form of Zantac is called Ranitidine, and for some people, it can be used in place of a PPI. It's cheaper than the PPIs, so it may be worth trying. I occasionally take 300 mg or Ranitidine at bedtime when the Nexium has worn off. It's not a perfect substitute for me, but Nexium is expensive. My father-in law has GERD, and when the PPIs gave him dry mouth, his doctor switched him to a 300 mg dosage of Ranitidine as well. 300 mg is a lot higher a dosage than what is on the package, but it can be safely tolerated. I don't know anything but doses higher than that.


Finally, you may want to visit an ENT, who can determine the amount of damage to your laryngeal area and confirm diagnosis. LPR = red and swollen larynx from the acid hitting it. If your diagnosis is correct, you are coughing because your poor larynx has no natural protections, yet it's getting splattered with acid. That's why your cough is non-productive. You are just trying to cough off the little bit of acid that is hitting the larynx, or possibly the little bit of acid that is getting into your lungs as well. An ENT will scope you by numbing your nose with spray, then inserting a very thin probe with a camera up your nose and down your throat. Sounds gory, but it doesn't hurt at all - it just feels a little weird.. Then the image comes up on a TV monitor - and the doc can see your larynx.

I don't know how long this has been going on for you, but if you have had this for more than a few weeks, you may or may not want to visit a Gastroenterologist. They do endoscopies - which is scoping your esophagous under heavy sedation or general anasthesia. It's ambulatory, and takes about 20 minutes for the procedure. The doc then takes biopsies of the esophagous (and stomach?) to look for cellular changes and dysplasia, which can be indicative of Barrett's esophagous, a condition which often develops after long-term acid reflux, and is a precursor to esophageal cancer. The PPIs are considered to be an excellent way to lower your risk of esophageal and laryngeal cancers.

It souns like you haven't had the reflux for too long because your tone was so mellow in your post. People who have had it for a long time and have gone untreated are typically a little frenetic! The great news is that this condition is typically highly treatable. Sometimes you need to play with the meds to find the right one for you, but you should be able to control your symptoms pretty easily once you begin some form of PPI or H2 therapy.

I've given you your options - but this is my personal advice - first ask your doctor for some samples of Nexium. Take 2 the first day, and see if you feel better. (When I did this, my 6 months of coughing ended in 20 minutes - AND I had been on 1x a day therapy for 3 months with no relief!!!).

If it works, at least you'll find some relief knowing you have a solution. If your insurance won't cover Nexium, I'd recommend finding out what they do cover, or trying the OTC med Prilosec. Prilosec did not work for me, but it's helped others.

 
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Old 02-21-2006, 07:51 PM   #3
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Re: Aspiration with acid reflux

One last thought -

In patients with severe GERD or LPR, treatment with PPI drugs is extremely effective. Symptoms often disappear quickly after these medications are started. However, one must keep in mind that the cause of the GERD -- the failure of the sphincter separating the esophagus from the stomach -- is a chronic problem that is not modified by medications. This explains why most people with severe GERD develop recurrent symptoms when they discontinue PPI therapy. Many patients who required twice-a-day doses of Prilosec or Prevacid to get their GERD under control will be able to cut the dose to once a day, but most will relapse if they stop the medication completely.

 
Old 02-21-2006, 08:00 PM   #4
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Re: Aspiration with acid reflux

Thank you aswander for your prompt and very informative replay. I guess I was too vague in my description of my problem. I have been having endoscopies every 2 years for the past 6 years. I was diagnosed with barrett's esophogus and the last time I was checked, everything looked ok. Years ago my gastrointerologist told me I did have larngeal pharyngeal reflux and explained something about a "flap" not opening and closing properly and that's why I choke easily. You are very precise in your prognosis and very knowledgable in what can be done. I've been on Aciphex for about 6 years now and for some reason, I still get the reflux. I take it each morning and I sometimes take Rolaids or Tums before bed (( get alot of heartburn). Sometimes I can just be sitting down and all of a sudden I reflux and get choked. I sometimes can't breathe and it feels like I've strangled on liquid. I hate choking, not being able to swallow sometimes and I hate this reflux. This episode I have now though is like I've got a horrid chest cold. I cough hard and my chest burns and aches. This steriod my doctor put me on has completely stopped my wheezing but the congestion is still bad. Whenever I get a chest cold, I seem to have to go on an antibiotic to cure it. That's why I don't know why he refused to put me on one now. Do antibiotics not work with steriods? I haven't been able to lay down and sleep in 4 nights now. The steriods have my heart beating rapidly and I feel worried. I called my doctor back today to tell him about this but he said to give the steriods the full 6 days and told me to take xanax for my anxiety. I have been drinking hot tea to try to relieve this chest congestion and taking muscinex expectorant. I just don't know what else to do. I guess I just wasn't sure HOW doc knew it was reflux and not a chest cold. I don't know why he feels steriods are the answer when I've never had them before. My grandfather died of esophogeal cancer (many years ago) and I have a brother and nephew who have had to have nissan fundoplication surgeries. I hope that's not my next step. I am so uncomfortable with this tight feeling in my chest right now though. Is this part of the reflux disease? Thank you again for any info you can provide!!

 
Old 02-22-2006, 06:25 AM   #5
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Re: Aspiration with acid reflux

Quote:
Originally Posted by catcopy
Thank you aswander for your prompt and very informative replay. I guess I was too vague in my description of my problem. I have been having endoscopies every 2 years for the past 6 years. I was diagnosed with barrett's esophogus and the last time I was checked, everything looked ok. Years ago my gastrointerologist told me I did have larngeal pharyngeal reflux and explained something about a "flap" not opening and closing properly and that's why I choke easily. You are very precise in your prognosis and very knowledgable in what can be done. I've been on Aciphex for about 6 years now and for some reason, I still get the reflux. I take it each morning and I sometimes take Rolaids or Tums before bed (( get alot of heartburn). Sometimes I can just be sitting down and all of a sudden I reflux and get choked. I sometimes can't breathe and it feels like I've strangled on liquid.
From what you are saying it sounds like your medication is not working. Perhaps you need to switch to a different PPI or increase the dose. How much Aciphex are you taking? You should talk to your doctor.

In the meantime, you could give Prilosec OTC a try. Its not that expensive.

 
Old 02-24-2006, 02:54 PM   #6
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Re: Aspiration with acid reflux

Catcopy,

It sounds like you have plenty of experience with Acid Reflux. I wish I had some constructive advice, but I really don't know what to do in your situation. My thougts are:

-Would an antibiotic really work? Has it worked before? Do you know if you had a bacterial infection before? Have you had chest x-rays? Most colds aren't caused by bacteria, but preumonia is frequently caused by bacteria, and taking any PPI increased your risk of developing pneumonia, especially if your immune system has been stressed.

-Go gently on the congestion/cold supplies. I personally struggle with this greatly, because my colds, always turn into bronchitis and this goes far back before I developed reflux. A 10 day cold easily becomes a 6 week nightmare, at least 2x a year. I've learned to manage my colds by hitting them as soon as they come on with a combination of advil and a decongestent - this reduceds the symptoms, and prevents the "pussing out" effect of the mucus in my lungs. I can even avert bronchitis this way. But since getting Acid Reflux over 3 years ago, the OTC cold rememdies/decongestents that I used to take KILL my stomach now. No more Dayquil/Nyquil for me - I'm now on a plain generic decongestent, without the frills. Even this isn't great for my stomach, but it's a lot more gentle than the dayquil/nyquil route. I also still take the Advil to reduce inflammation.

-Though it sounds to me like your chest congestion and cough is acid-related, another possibility (albeit a much weaker possibility) is that you have some kind of fungal infection in your lungs. Several fungal infections that are fairly common in the U.S. turn opportunistic in patients with compromised immune systems - so people who seem otherwise healthy can be affected. I'm thinking primarily about Coccidioidomycosis (San Joaquin Valley Fever). You get this by inhaling spores into the lungs, and while most people dont' develop any real signs of infection, 1% of patients develop symptoms that are simliar to Tuberculosis. While you probably don't have this, I just thought I'd bring it up because it's mostly a regional problem as the fungus is found in the soils of the U.S Southwest. My best friend was a recovering anorexic (but still too skinny), took a business trip to Arizona, and developed this infection after her return to NYC. The fungus took hold because her system was so run down by the anorexia. It took a really long time for her to get a diagnosis. I'm not a health professional - just an interested student of microbiology.

-I agree with ADGRANT that perhaps you need to find a new PPI. I strongly recommend Nexium at the 2x per day level. (I sometimes take it 4 times per day if it's really bad). My LPR doctor (affiliated with Yale University School of Medicine) swears by 2 doses of Nexium a day for her LPR patients. She says it is better metabolized by most people. But with your family history, it sounds like there is a predisposition to severe acid reflux and that you have an uphill battle ahead of you. Were the fundos successful in your relatives?

-As far as putting you on Xanax for anxiety, I highly recommend against this. First, Xanax is a muscle relaxer (more so than Advil) and can contribute to further weakening of the esophageal spinchter muscles. It is also highly highly addictive at very low levels. Before I was diagnosed, I spent 6 months in a sheer hell searching for a diagnosis and was put on Xanax. Though I absolutely did not "abuse" the drug in any way and followed my doctor's strict dosage schedule, I nonetheless developed a physical dependence on the drug after 1 month. My reflux also steadily worsened during this time. After getting the reflux diagnosis, I had to detox off the Xanax - and let me tell you, I was so ready and happy to give that drug the kiss-off, but I went into withdrawl symptoms every time I tried to even lower the dose - and I was - get this - only taking 1 mg, 3 times a day. Physiological dependency can exist separate from a predisposition to addiction. Once I was detoxed from this drug, I never had any desire to use it again. Of course, the fact that my acid reflux was now under treatment eliminated the anxiety. So anyway, if you must take it, do not use it round the clock, and try not to use it for more than a few days in a row.

 
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