I have fairly severe asthma and am being treated with the following meds
to keep my asthma under control:

Ventolin
Atrovent
Serevent
Flovent
Theophylline
Prednisone

However, they have now added two more {*filter*} as they seem to think that
Gastroesophageal Reflux might be making my asthma difficult to treat.

They are called Ranitidine and Losec.  Could anybody tell me what the
connection is between Gastroesophogeal Reflux and difficult to treat
asthma and how these two {*filter*} control the G. Reflux ?

I am going for an upper GI test later this week to test for the presence
of the G. Reflux.

Any information would be helpful.  I have had severe asthma for about 8
years now and this is the first time that they have investigated the
G. Reflux thing.

Amber  

I have fairly severe asthma and am being treated with the following meds
to keep my asthma under control:

Ventolin
Atrovent
Serevent
Flovent
Theophylline
Prednisone

However, they have now added two more {*filter*} as they seem to think that
Gastroesophageal Reflux might be making my asthma difficult to treat.

They are called Ranitidine and Losec.  Could anybody tell me what the
connection is between Gastroesophogeal Reflux and difficult to treat
asthma and how these two {*filter*} control the G. Reflux ?

I am going for an upper GI test later this week to test for the presence
of the G. Reflux.

Any information would be helpful.  I have had severe asthma for about 8
years now and this is the first time that they have investigated the
G. Reflux thing.

Amber  

GastroEsophageal Reflux Disease (GERD) allows stomach contents to back
up into the esophagus and frequently into the airway while lying down
or sleeping.  Hence it can make asthma worse, or can imitate ashma
where none actually exists.  Prevailing opinion is that it is due to
incompetent gastroesophageal sphincter muscle (valve at bottom of
esophagus where it enters stomach).  Aside from surgery to fix muscle,
acid control via {*filter*} seems to be main therapy.  Modification of
eating habits and sleeping posture are also recommended.

I do not have asthma, but when I am not taking Prilosec (another brand
of omeprazole or Losec), I can awaken at night gagging on reflux and
have a case of pneumonitis the next day, sometimes with a fever.

I took over-the-counter antacids and prescription Tagamet (cimetidine)
for years before I was put on Prilosec a few years ago.  Since then I
have almost zero problem with GERD, although I am still careful about
what I eat before bedtime.  I also sleep with upper body elevated as a
further precaution.

Even if you are not aware of burning in throat or chest (heartburn)
either during the day or while lying down to sleep at night, you might
still be refluxing while sleeping, thus aggravating your asthma.  That
is why they want to try the Losec.

If reflux is a problem for you, I would certainly wonder about
possible aggravation of GERD by all of the other {*filter*} you are taking.
With that many meds, how can anyone figure out what is causing what?
Many meds have gastrointestinal side effects.

Dick

Addendum to my last post:

Ranitidine (Zantac), like Tagamet, is an H2 blocker which inhibits
acid production system but also affects other systems.

Omeprazole (Prilosec) and Losec are "proton pump inhibitors" which
more directly inhibit acid production in stomach and therefore seem to
have a more focused effect without some of the systemic side effects
of the H2 blockers.  Lansoprazole (Prevacid) is another drug in the
same family.  Prilosec and Prevacid are sustained release, so for many
people it is a one a day regimen.  Losec is an earlier drug in family.

Dick

I assume the reason they are investigating the gastroesophageal reflux
aspect is that when you are lying flat in bed the acid from your stomach
could have backed up far enough that some of it was getting in your lungs.
Having a dose of stomach acid every night in your lungs could cause
pneumonia and asthma symptoms.

I assume they have given the usual advice about putting blocks under the
head of your bed and not eating or drinking anything the last few hours
before going to bed (so the stomach won't be full).  Normally if a patient
fails on Zantac they switch to Prilosec (omeprazole) or Prevacid
(lansoprazole). Since the Proton pump inhibitors are so much more potent
than the H2 inhibitors, there's no need to take Zantac too if you are on
Prilosec.

Fully agree with{*filter*}. There is a GERD-mechanism that plays a role
(primary, secondary or contributory). Asthmatic process in these cases
may greatly depend on gastric reflexes. If the condition is suspected
proton-pump inhibitors(omeprazole) and iprat{*filter*} bromide (Atrovent)
are added.As th pt.has possilbe GERD it may be rational to discontinue
Theophylline as it rises the production of stomach acid and
complicating the situation. The aspect of surgery is full of
controvercy: pt.has a long history of asthma and (I give 90 % chance)
there has been changes in mucosal and submucosal layers of the bronchi
that are typical for asthmatics to have :autoimmune inflammation,
mucosal edema, smooth muscle spasms (and all autoimmune mechnisms that
may be involved like hyper IgE-emia, eosinophilia, mucosal changes,
etc).If this is so, there might be a great chance of intolerance of
anesthetics -- anaphylaxis. Even with 8 yr. Med hist of asthma
endoscopy is sometimes dangerous because of possible copmlications.
Rph's will agree that sometimes ranitidine does interact with
Thephylline,though clinical significance varies from pt to pt. There
are reports of increased serum levels of theophylline when on
Ranitidine.Prilosec here is safer.
Andy

How long have you taken Prilosec?  It was prescribed for me a few years
ago, but at that time my doctor said it should only be taken for 90 days
at most without a break.  I didn't take it at all for a few years, and
now my current doc has me on it with a PRN script.  I'm to take it and
Propulsid every day.  Has the thinking changed about taking Prilosec for
the long term?  I did ask my doc, but we were talking about lots of
stuff and he just reassured me that it was OK to take it.

Thanks.

mary

I've been on Prilosec for about 3 years.  The earlier labeling
warnings about long term use have been dropped (FDA action in 1995).
There were concerns about cancer due to lab rat studies during
testing, but years of Prilosec use in USA and abroad have not
supported this fear.  As always with potent {*filter*}, there is still
risk, but the risk of not taking the drug is more significant in many
cases.

Dick

J.R. RPh.