GASTROESOPHAGEAL REFLUX (GERD): A MAJOR FACTOR IN HIGHLY LABILE STEROID-DEPENDENT ASTHMA

Introduction In the setting of severe asthma with difficult to control symptoms, it is crucial to evaluate for other diagnoses and comorbidities in order to optimize management. In the case presented, sub-optimally treated GERD was identified as the driving force causing severe asthma symptoms. Case Description A 13-year-old female was evaluated for systemic steroid-dependent asthma. She reported frequent sudden-onset nocturnal dyspnea that was partially responsive to bronchodilators. She had one ICU admission and two near-syncopal events due to severe respiratory distress in the past year. Episodes persisted despite taking 2 mg/kg of prednisone, daily. Bronchoscopy and high-resolution chest CT were unremarkable. A 24-hour pH / impedance probe study identified excessive acid and nonacid reflux reaching the proximal portion of the esophagus and pooling of fluid in the esophagus. High-dose proton pump inhibitor therapy was initiated, and prednisone was tapered without worsening of her asthma. Discussion As in the case presented, ongoing reflux can manifest as highly labile difficult to control asthma even in the absence of typical reflux symptoms. It is important to consider an impedance study to assess for ongoing GERD in patients with difficult to control asthma. If present, optimizing GERD management with acid suppression therapy and, in some cases, surgically with fundoplication, may be necessary to control severe asthma symptoms.