Asthma patients need to be screened for gastroesophageal reflux disease

  Reflux asthma is one of the extraesophageal manifestations of GERD. Patients often also have the clinical manifestations of GERD such as acid reflux, heartburn, abdominal distension, and warmth, but a significant number of patients have only mild acid reflux or heartburn, or even no acid reflux or heartburn. Gastroesophageal reflux-derived asthma is more likely to have the following characteristics: (1) wheezing is mainly difficult to inhale; (2) cough and wheezing are not obviously seasonal; (3) cough and wheezing mainly occur at night; (4) cough and wheezing are easy to occur in a lying position and can be relieved after sitting up; (5) cough and wheezing are easy to occur after a full meal or eating spicy food; (6) breath-holding can be relieved or alleviated after warming; (7) there is also unexplained pharyngitis, highly suspected to be caused by gastroesophageal reflux, manifested by dry throat, itchy throat, foreign body sensation in the throat, hoarseness, repeated laryngospasm attacks, etc.; ⑧ other extraesophageal manifestations of gastroesophageal reflux, such as reflux rhinitis, sinusitis, otitis media, dental erosion, etc., were confirmed to exist; ⑨ allergen tests were negative or there was no coughing and wheezing after contact with allergens; ⑩ no pulmonary lesions were found on chest X-ray, chest C T, etc.  Diagnostic tests: 1. Gastroscopy: It is possible to find out whether there is esophageal erosion and the degree of erosion, and whether the cardia is relaxed; 2. 24-hour pH monitoring: For non-erosive GERD without mucosal breakdown, this test is the “gold standard” and can clarify whether “asthma “3. Esophageal manometry: important for the diagnosis of esophageal motility disorders; 4. Intraluminal impedance monitoring: can monitor reflux with p H > 4, and can clarify whether “asthma” symptoms are related to reflux.  Treatment: 1. In order to reduce reflux at night and in the recumbent position, it is advisable to adopt a sloping position (only elevating the head is not enough) or to elevate the head of the bed appropriately; eat slowly, have small and frequent meals, avoid lying in bed immediately after meals, and adopt the recumbent position only after at least 2 hours; reduce factors that lead to increased abdominal pressure, such as not tightening the belt, avoiding constipation and controlling body weight; try not to consume high-fat foods, chocolate, coffee, and strong tea. Avoid high-fat food, chocolate, coffee, strong tea, and abstain from alcohol; 2. Drug therapy: H2 receptor antagonists, proton pump inhibitors, prokinetic drugs, mucosal protective agents, bronchodilators, anti-inflammatory drugs; 3. Endoscopic esophageal microcurrent radiofrequency therapy; 4. Laparoscopic fundoplication.