question - Asthma Message Board

Stoney109 · 07-17-2006, 04:26 PM

ive had acid reflux for 8 months, didnt have breathing probs until then. shortness of breath, feels heavy, wheeze when breathing deep, coughing, and breathing just feels like i was outside running during the winter time when its freezing. have one of those symptoms all the time, but its a lot worse, starting around 4-6pm every day. does that sound like asthma. doc gave me flovent and i have an albuterol inhaler from when i went to the er a few times. never had an attack..is that what it feels like though, like you were just outside excersizing in the cold?

Maxibear · 07-18-2006, 05:50 AM

Acid Reflux easily mimics asthma, but if it's reflux, you basically won't respond to the asthma medications.

The type of reflux that causes asthma-like symptoms is called LPR, short for Laryngopharyngeal Reflux. As the name implies, the acid is rising further up the esophogous that with regular reflux, and is actually irritating your pharynx, larynx and throat.

LPR requires more aggressive treatment that it's better known counterpart, Heartburn, which strikes the lower esophogous.

While Heartburn requires one daily dose of a PPI (proton-pump inhibitor) to clear it up, LPR requires 2 daily doses of a PPI to control it. LPR typically must be treateed with a PPI indefinitely, as it's typically a permanent condition. Luckily, most LPR patients respond to 2x daily dosing treatment very well.

The first thing you need is a prescription PPI. (DO NOT TRY PRILOSEC OTC - it doesn't work for LPR at all).

You will need the highest doses of medication in each inidividual pill. For instance, while NExium comes in the 20mg and 40 mg size pill, you will need 2 40 mg pills.

Your prescription choices are:
Nexium
Prevacid
Aciphex
Prilosec (BRAND, not OTC)
Protonix (but I wouldn't recommend it)

The reason LPR mimics asthma is basic engineering. If the acid is rising so high in the esophogous that it gets to the larynx, and the larynx is located next to the opening of the trachea (the windpipe), often a small amount of acid gets aspirated back down the trachea and gets into the lungs. The lungs have no protection against the acid, and it causes irritation, then you get asthma symptoms.

I no longer have symptoms and have been on the dual dose therapy for 4 years.

You can ask your PCP to prescribe this for you. There is plenty of information at pubmed that supports the dual dose therapy if your doctor argues with you.

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=12671413&query_hl=9&it ool=pubmed_docsum[/url]

There are plenty more articles there if you wish to browse it.

Stoney109 · 07-18-2006, 09:44 AM

lol thx for the info..im on 1 40mg nexium in the morning and zantac 150 in the evening. it's been doing alright, the zantac seems to help more than the nexium. i started using the flovent yesterday, a definite improvement. idk why i would have asthma, there's no history in my family at all with it. its gotta be from the reflux.

aswander · 07-18-2006, 03:31 PM

No, I don't think the Zantac helps you more than the Nexium. Nexium is much much stronger than Zantac. Zantac is part of an earlier generation of acid reducers called H-2 inhibitors. These H-2s are now all sold OTC, under names like Zantac and Tagamet. They are very useful in relieving occasional heartburn, but typically aren't very useful for LPR.

The new generation of acid reducers are called Proton Pump Inhibitors (PPIs). They are much stronger. The first one, Prilosec, was introduced 19 years ago. The latest one, Nexium, debuted in 2002 or 2004. Nexium is the most structurally different of all the PPIs. Currently, the only PPI to be sold over the counter is called Prilosec OTC, but this is not the same medication as the old prescription Prilosec, which is still available by prescription as Prilosec.

The PPIs are much more effective than the H-2s, especially for chronic hearburn or LPR.

Here's why you are feeling better at night: you told me that you take the Nexium in the morning, and a Zantac at night. LPR sufferers are different from heartburn sufferers in a very unique way. Most people with LPR reflux most during the day, and when they are upright. Most people with LPR find that lying down and/or sleeping makes them feel better. (This was also true for me). So you may think that it's the Zantac, but it's actually the position that is helping you.

Take it or leave it, but 2 PPIS per day is the way to go. You can even take the PPIs together first thing in the morning. The medication in them lasts abotu 14 hours, so when it's time to go to sleep, you don't have to take another pill. Lying down will get you through the rest of the night pretty well.

Stoney109 · 07-18-2006, 04:29 PM

yeah...i was on 2 a day, still nothing. still have the symptoms..the cause of my probs im pretty sure was all due to when i had mono and a serious tonsil infection last dec. i think and my reg doctor thinks it just changed my body, also because tests show nothing wrong. hoping it will re-adjust in time, soon hopefully im only 20 yrs old by the way as well