Conditions / Respiratory Reflux
Airway Reflux / Laryngopharyngeal Variants
Affects an estimated Up to 25% of chronic respiratory diseases
Overview
A subset of LPR where refluxed material reaches the bronchial airways. Can mimic or worsen asthma, cause recurrent pneumonia, and is a common undiagnosed cause of chronic bronchitis. Pepsin has been found in the lungs of these patients.
How it's diagnosed
pH-impedance monitoring with proximal sensors. Pepsin detection in bronchoalveolar lavage fluid. Response to aggressive acid suppression therapy.
Triggers
- Nighttime reflux particularly dangerous
- Lying flat
- All standard GERD triggers
- Any form of reflux that reaches throat level
Symptoms
- Chronic cough (especially at night)
- Worsening asthma
- Recurrent pneumonia
- Chronic bronchitis without clear cause
- Wheezing
- Morning hoarseness
Complications if untreated
- Aspiration pneumonia
- Worsening asthma control
- Pulmonary fibrosis (rare, long-term)
Immediate relief
- Head elevation while sleeping is critical
- Semi-recumbent position (45°) for sleeping
Long-term management
- Twice-daily PPI minimum
- Alginate therapy before bed
- Surgical treatment evaluation if severe
- Coordination between gastroenterologist and pulmonologist
Diet
Strictest pre-sleep protocol: nothing by mouth 4 hours before bed. Liquid antacid/alginate immediately before lying down.
When to see a doctor
Coordinate between gastroenterologist and pulmonologist or ENT. Lung involvement makes this more serious than standard GERD.
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