An interesting article in today’s New York Times reports that esomeprazole- aka Nexium- is ineffective at treating poorly controlled asthma. Esomeprzole is a proton pump inhibitor, a widely used class of medicines used to treat gastric reflux.

Why would anyone think that a medicine which reduces stomach acid might treat asthma? The article states that doctors have noted that people with asthma are more likely to have gastric reflux than non-asthmatics. Some studies have found estimated that over 40% of people with asthma have gastric reflux, compared to 5-10% estimated for the general population. 

I experienced the connection between stomach acid and breathing difficulty quite dramatically. One night, out of nowhere I woke up unable to breath. I don’t know how long it went on for, but it felt like forever. I was pretty freaked out and went to see the doctor the next day.

The first question she asked me was, ’did you have any unusual taste in your mouth?’ I had, but didn’t think it was related. Specifically I had a strong sour taste. She explained that stomach acid- which like all acid tastes sour- can churn up in to your mouth while you sleep. When it does, some might start to go down your trachea- or windpipe- which triggers your breathing to shut down, as a protective mechanism. She called what I experienced as paroxysmal nocturnal dysmia  or PND.

About 2 years ago, I was driving with Marty Delaney- and he shared with me that he had been having bouts of waking suddenly unable to breath. His doctors had done a typical sleep apnea work up, showing he didn’t have that problem. Remembering my incident, I asked him if he had a sour taste in his mouth when this happened. Turned out he did- and he started taking acid reducers before bed and the problem went away.

While the study found no benefit to use of esomeprazole, there is reason for further study- possibly in people who have clear cut cases of reflux.

I am no expert on asthma. I do know that it can be triggered by many things, including exercise, allergies and so on. The connection between reflux and asthma is unclear- is it cause, effect or simply conincident? Some studies have shown improvement in asthma symptoms from reflux treatments- both drugs and surgery. This newest study didn’t, but it looked at anyone with poorly controlled asthma. Perhaps if people with document reflux, plus poorly controlled asthma were studied the results would be different.