Gastroesophageal Reflux Disease-Related Asthma: Neurogenic Inflammation and Non-pharmacological Management

Abstract

Asthma is a chronic inflammatory airway disease characterized by bronchoconstriction, airway remodeling, and increased responsiveness to non-specific stimuli. Adult-onset asthma is often associated with environmental and individual risk factors rather than allergens. One important contributing factor is gastroesophageal reflux disease (GERD), which can worsen asthma symptoms through microaspiration of gastric contents and vagally mediated reflex mechanisms. GERD is a chronic gastrointestinal disorder characterized by the reflux of gastric acid into the esophagus, influenced by factors such as obesity, smoking, certain medications, and stress. Evidence shows a strong association between GERD and asthma, with studies reporting that up to 80% of asthma patients experience reflux symptoms such as heartburn and regurgitation. Acid exposure in the esophagus can trigger neurogenic inflammation through activation of vagal pathways and release of neuropeptides, leading to airway hyperresponsiveness and bronchospasm. In addition, chronic exposure to refluxate may directly injure airway epithelium and increase inflammatory cell infiltration. Understanding this pathophysiological relationship is essential for improving asthma control. Non-pharmacological management plays a key role in reducing GERD-related asthma symptoms. Effective strategies include avoiding trigger foods, maintaining a minimum three-hour interval between meals and sleep, elevating the head during sleep, achieving weight loss in overweight individuals, and smoking cessation. These interventions have been shown to reduce reflux episodes and improve respiratory outcomes.