GERD (Gastroesophageal reflux disease) is the term used to describe the regurgitation of stomach acid and other stomach contents into the esophagus. Although irritation of the esophagus by gastric acid can cause heartburn, many individuals can have significant reflux without any symptoms.

GERD can be associated with asthma, in that gastric acid in the esophagus can sometimes trigger nerve reflexes that narrow the airways of the lungs, thus worsening asthmatic symptoms. This effect can be further worsened if small amounts of gastric contents are sucked into the upper airways, where they cause more wheezing, coughing, and shortness of breath.

Since GERD is more common in people with asthma than in non-asthmatics, treatment guidelines have recommended that doctors ask asthma sufferers about heartburn and even carry out special tests on them to diagnose GERD. This is all fine and good, but—and here's the problem—many physicians have rather routinely used heartburn medications as part of their routine treatment of asthma, whether the patient has symptoms of GERD or not.

The April 9 issue of the New England Journal of Medicine described the results of a trial that randomly assigned 412 men and women with asthma to take either a placebo or a commonly used proton-pump inhibitor, esomeprazole (Nexium), to slow the formation of stomach acid. The researchers found that asthma was poorly controlled in the participants, despite the administration of their usual asthma drug therapy.

According to surveys, large numbers of asthmatics are taking proton pump inhibitors, which cost between $150 and $180 per month. In addition, the tests to prove the presence of gastric acid reflux are expensive. These drugs are safe and work well to reduce gastric acid but, because they do not appear to improve symptoms in asthmatics with no symptoms of GERD, the authors of the paper recommend that physicians only consider their use in those people with asthma who have GERD symptoms at least twice a week.

In two earlier trials, proton-pump inhibitors also showed little or no benefit in asthmatics who had no GERD symptoms. An editorial in the same issue of the New England Journal of Medicine concluded that "empirical treatment with proton-pump inhibitors does not make sense."

I suggest that you contact your doctor if he or she has prescribed a proton-pump inhibitor for your asthma even though you rarely have symptoms of GERD.