Gastroesophageal reflux can cause asthma through a variety of mechanisms, but can long-term asthma cause reflux? Research suggests that asthma may increase the risk of gastroesophageal reflux disease (GERD). The results of the study were published in the journal Chest (Chest 2005;128:85-93). Study leader Ana Ruigomez, MD, of the Spanish Center for Epidemiology, and colleagues noted, “The results of this study show that asthma is associated with the subsequent diagnosis of new-onset gastroesophageal reflux disease (GERD), mostly occurring within 1 year after the diagnosis of asthma. Understanding this possible correlation may help physicians properly evaluate and treat patients with asthma who may misinterpret it as part of the symptoms of a whistling disease.” Dr. Ruigomez and colleagues called on data from the UK Comprehensive Medical Research Database to analyze the relationship between asthma and gastroesophageal reflux disease (GERD), to clarify whether GERD predisposes to new cases of asthma and whether asthma predisposes to new cases of GERD. In total, the researchers evaluated the incidence of asthma in 5,653 patients with a first diagnosis of gastroesophageal reflux disease (GERD) and the incidence of GERD in 9,716 patients with a first diagnosis of asthma. The results of the study showed that the relative risk of asthma in patients with newly diagnosed gastroesophageal reflux disease (GERD) after adjusting for other associated factors was 1.2 after 3 years compared to controls, which was not statistically significant, while the relative risk of GERD in patients with newly diagnosed asthma after adjusting for other associated factors was 1.5, which was statistically significant. So, why do patients with chronic cough and asthma develop reflux? The most likely reasons are: (1) Long-term recurrent airway obstruction and hyperinflation of the lungs in asthmatic patients result in increased negative thoracic pressure, increased intra-abdominal pressure, and increased thoracoabdominal pressure gradient, while forceful inspiration decreases lower esophageal pressure and reduces lower esophageal sphincter tone, resulting in the occurrence and aggravation of GERD in asthmatic patients. (2) In bronchospasm, the lungs are overinflated, causing the position of the diaphragm to fall in asthmatic patients, and its role in enhancing the tone of the lower esophageal sphincter is weakened, which can also cause GERD. (3) The stimulation of pulmonary tensor receptors by bronchospasm, lung overinflation and hyperinflation reflexively causes relaxation of the lower esophageal sphincter, causing reflux to occur. (4) Bronchodilator drugs are commonly used in the treatment of asthma. These drugs relax the smooth muscle of the airway and also relax the esophageal sphincter, reducing the tone of the lower esophageal sphincter and weakening the function and role of the esophageal sphincter in preventing reflux. The application of theophylline drugs for croup can increase gastric acid secretion, and studies have shown that asthmatic patients with theophylline blood levels at therapeutic levels have a higher prevalence of GERD disease than patients who do not reach therapeutic levels. Systemic use of adrenergic agents can also decrease lower esophageal sphincter tone and reflux can occur. In addition to the existing cough and asthma symptoms, reflux symptoms such as acid reflux and heartburn may occur in patients with asthma, reducing the quality of life; at the same time, reflux can cause and aggravate asthma and worsen cough and asthma; the vicious circle of reflux and asthma interacting with each other can lead to progressive exacerbation of GERD or intractable asthma. In terms of treatment, asthma patients with complications of reflux should first also treat cough and asthma and control airway inflammation. Only by controlling the primary factors causing reflux can reflux be better controlled, and on the basis of controlling the symptoms of the whistling tract, proton pump inhibitors are mainly applied, commonly used are esomeprazole (Nexium), rabeprazole (Polite), whose inhibition of the proton pump is irreversible, and after application will reduce The acidity of the gastric juice, thus reducing the irritation of the esophagus and thus the symptoms of reflux; it should be noted that reflux may still exist after the application of proton pump inhibitors, only the irritation is reduced; another mechanism is that when the acidity of the gastric juice is reduced, the tone of the lower esophageal sphincter increases, thus reducing the chance of reflux. Second, gastric motility drugs, mainly domperidone (morpholine), can be applied to reduce the chance of reflux by accelerating the emptying of gastric juice. Unlike other gastric motility drugs (cisapride, etc.), domperidone also has the effect of increasing the tone of the lower esophageal sphincter, but recently it has also been suggested that gastric motility drugs do not have much practical role in reflux treatment. Again, antacids and gastric mucosal protectors can be applied, mainly to neutralize gastric acid, with magnesium aluminum carbonate tablets as the main representative. If a patient with asthma complicated by reflux is treated for reflux with further reduction of cough and wheezing symptoms based on the control of reflux symptoms, it means that the reflux caused by asthma in turn aggravates asthma, then more attention should be paid to the treatment of reflux, at which time micro radiofrequency treatment of reflux or minimally invasive laparoscopic surgical treatment can be considered.