1. Case report of a male, 68 years old, with recurrent cough, sputum, laryngeal constriction (laryngospasm), and dyspnea for 16 months. In October 2004, the patient developed a persistent cough, runny nose and sneezing, which was diagnosed as “cold” or “allergic rhinitis” and was ineffective in taking various medications. Later, the cough, runny nose and sputum worsened, and the tightening of the larynx (unbuttoning the collar did not help) and even dyspnea gradually appeared. The onset of symptoms is closely related to eating and sleeping. The onset of coughing must occur when eating: coughing occurs after a few bites, stops when not eating, and coughs again when eating again, which not only makes it difficult to eat, but also obviously causes the necessary social difficulties. The patient’s cough and sputum must occur every night, sometimes to the point of death, and with varying degrees of dyspnea, all at 2 to 3 o’clock at night (sleeping pills do not prolong his sleep), and the symptoms disappear quickly most of the time after getting up and changing to an upright or sitting position with coughing and sputum. From January to October 2005, he was forced to be admitted to the emergency room and hospitalized four times due to extreme nocturnal dyspnea that continued to worsen. Each time, the patient was diagnosed as having an acute attack of bronchial asthma and was treated with oxygen, bronchodilation, intravenous and oral cortisone, etc. The symptoms resolved within a short period of time and the patient was discharged from the hospital and could go to work immediately. The patient did not have acid reflux or heartburn, and recalled occasionally having mild retrosternal pressure, but no abnormalities were found in the electrocardiogram that followed. Stomach contents had been coughed up once during a very severe cough. He was first diagnosed by an otorhinolaryngologist as “typical allergic rhinitis”, and was subsequently diagnosed by other physicians as “allergic bronchial asthma” and recurrent acute attacks. The laboratory examination did not show any significant abnormalities. Chest CT, MRI and bronchoscopy did not reveal any tracheal or pulmonary lesions. During the fourth hospitalization in October 2005, the patient insisted on gastroesophageal reflux examination, including 24-hour pH monitoring of the esophagus: a total of 21 hours and 23 minutes were recorded, and it was found that the total number of refluxes was 220, and the reflux time accounted for 9.7%, with 7 refluxes longer than 5 minutes and the longest reflux time of 40.3 minutes. It occurred at 22:58, with a total reflux time of 169 minutes and a DeMeester score of 84.4. Esophageal sphincter length under manometry was 2.5 cm, LESP 4.5 mmHg (normal 10-45 mmHg), relaxation pressure -26 mmHg (less than 8 mmHg), relaxation rate 20% (normal 80%), and remote esophageal peristaltic wave amplitude 39 mmHg (normal > 50 mmHg). normal >50 mmHg). Gastroscopy did not show erosive esophagitis or other abnormalities, and the PO2 was 81 (normal 81-103) and SpO2 was 86% (normal >97%) under oxygenation at the time of emergency admission in February 2005. He had a history of physical fitness, denied any history of smoking or alcohol, no history of surgery, and denied any history of food or drug allergy; there was no family history of bronchial asthma. The patient carefully recalled that he had woken up once during 2002-2003 with a mild rustling sound in the right upper chest lasting several seconds, which disappeared immediately after a slight change of position without any other discomfort. At 10:00 on February 9, 2006, he visited the stomatology department because of toothache. At noon, just a few sips of drink immediately led to a heavy cough, sputum that could not be easily coughed up, a feeling of extreme tightness in the throat, and difficulty in gasping for air, and when he was sent to the respiratory ICU for resuscitation, cyanosis had already occurred. Thereafter, he took Nexium (esomeprazole) 40mg in the morning, omeprazole 20mg in the afternoon and 10mg domperidone before three meals daily, and his symptoms were relieved. On March 26, 2006, this patient, who was suffering from “bronchial asthma”, finally underwent laparoscopic fundoplication and the next day barium meal imaging. The next day, the barium meal was reported to be “fluoroscopic, the barium passed smoothly without obstruction or reflux”. From the beginning of the operation, the patient did not have any coughing during meals or regular awakening at night, coughing, coughing sputum, dyspnea, and could fasten the belt, and her voice gradually became clearer than before the operation, which was mildly hoarse. At the follow-up visit 84 days after surgery, there was no cough or respiratory discomfort, and he walked, walked upstairs and trotted without any problem, and has not taken any medication for GERD or asthma since surgery. In addition, this patient has written several articles on the theme of “GERD, not asthma” since the second day after the operation, and has contributed to the establishment of the first GERD center in China and the introduction of the Stretta microwave radiofrequency device for the first time in China, which has relieved 11 similar patients from severe suffering. The first GERD center in China was established and the Stretta microwave radiofrequency device was introduced for the first time in China, thus relieving 11 similar patients from severe suffering, including one patient with 20 years of misdiagnosed asthma, one patient with spontaneous pneumothorax, one patient with three ineffective coronary stents, and one patient with left lung resection. 2. When patients develop extraesophageal manifestations, especially respiratory complications, such as asthma-like attacks (but in fact not asthma, but laryngospasm) and even asphyxia, the patient’s life can be endangered. The case described in this article did not have symptoms such as heartburn and acid reflux caused by gastroesophageal reflux disease itself, but was characterized by extraesophagogastric clinical manifestations, i.e., persistent cough, sputum production, laryngeal constriction and severe respiratory distress, which made it easy for the physician to think of and even insist on the diagnosis of bronchial asthma very stubbornly, and all five emergency admissions were characterized by severe respiratory symptoms, and each admission was followed by oxygen, bronchodilators and intravenous applications. Bronchodilators and intravenous hormones were effective in real time after each admission, which convinced these physicians of the diagnosis of an acute bronchial asthma attack. It is worth considering why the patient’s symptoms not only did not improve but also worsened after regular and even increased doses of various powerful bronchodilators and inhalation preparations (e.g., sulforaphane), with persistent cough, sputum, and varying degrees of laryngospasm and dyspnea occurring regularly at each meal and during each night’s sleep. And why instead it was at the patient’s insistence that the presence of gastroesophageal reflux disease was clarified by a series of tests done at the gastroenterology department. Is it necessary to consider at this point not only that asthma can be a complication of GERD, but also that GERD is the only pathogenic factor for all clinical manifestations? Is GERD exacerbated by powerful medications for asthma? In the subsequent three months of regular application of PPI (e.g. Nesin, omeprazole, etc.) and gastrointestinal motility agents (e.g. martinoline), despite the improvement of the patient’s respiratory symptoms, the symptoms rebounded, i.e. were more aggravated, during the drug taper, and at the time of his 5th emergency admission to the hospital for resuscitation, the PO2 was 81 and SpO2 was 86% in the oxygen administration state, meeting the criteria for emergency tracheal intubation and application of ventilator, what risky. In fact, the lower esophageal sphincter was scientifically found to be significantly relaxed by esophageal manometry, an organic lesion not reversible by drugs. The continuous reflux of 40.3 minutes was found to occur at exactly 22:58 on the esophageal pH test, thus the onset of severe respiratory symptoms between 2 and 3 am is quite natural, and although the patient already knows how to adopt a proper sleep position and how to apply medication, to save him from this, it is necessary to address the lower esophageal relaxation in a substantial way to achieve an effective prevention of gastroesophageal reflux. The key problem is the prevention of esophageal reflux. Current treatment options include transgastric Stretta radiofrequency, endoluminal plication, full-thickness folding, and polypoid injection, but the patient opted for laparoscopic gastric body folding. All respiratory manifestations of the patient disappeared immediately after the operation and all medications for asthma and gastroesophageal reflux disease were discontinued, so the recent outcome should be considered very satisfactory. Although the patient had a slight difficulty in swallowing for a few days after surgery, he recovered quickly. The postoperative barium swallow proved to be smooth, and there was no gastroesophageal reflux. This is the best result, but the demand for 100% efficacy may lead to dysphagia. In fact, even a small amount of postoperative reflux can provide significant relief, as long as it is not enough to cause severe respiratory distress (or severe heartburn and reflux). If mild symptoms remain after surgery, a small amount of medication may be taken. In case of medium to long term recurrence, a small amount of medication for GERD should be taken when the symptoms are mild, or if it is not tolerated, a minimally invasive method such as Stretta radiofrequency can be added to treat the esophagus from the inside, in fact a combination of internal and external treatment is likely to achieve the best results. In addition, as seen from the barium swallow, the patient’s esophagus can be seen to have a tiny beak-like opening at the tip of the esophagus, which is exactly the pharynx, when the gastroesophageal reflux reaches this narrow part, according to Poiseuille’s Law, the flow velocity of this part suddenly accelerates, forming a spray-like rapid airflow, which will be the reflux This can cause invasion of the laryngotrachea, pharynx, sinuses, teeth, and even the eustachian tube, and cause symptoms. The spasm and strong respiratory irritation of the larynx and trachea caused by the reflux spraying into the laryngotrachea is self-explanatory, which is the reason why the respiratory manifestations in this case were so severe. This further suggests that providing substantial and reliable treatment of the relaxed lower esophagus in this case could be life-saving. This paper reports a case with severe or fatal respiratory manifestations that has been misdiagnosed and mistreated as asthma, but can be cured according to GERD, which shows the hard facts that the patient has GERD and not asthma at all, and reminds the medical profession and the public to be more aware of GERD, especially its extra-gastroesophageal clinical manifestations, so that more patients can be correctly and timely diagnosed and effectively treated. This paper also presents the results of the study of GERD. This paper also presents the microdrip ejection from the throat caused by GERD and its possible mechanisms. It seems that GERD is a disease that affects people’s health as much as hypertension, heart disease, diabetes, asthma, etc. We hope that the concept of “GERD, not asthma”, which is applicable to a certain group of people, will enhance the attention of the domestic and foreign medical community to the extra-esophageal manifestations of this disease, and conduct more in-depth discussions and studies. We hope that the concept of “gastroesophageal reflux disease, not asthma,” which is applicable to a certain group of people, will enhance the attention of the domestic and foreign medical community to the extraesophageal manifestations of this disease, and conduct more in-depth discussions and research for the benefit of patients.