Pneumonia

The symptoms of pneumonia may include:

Pneumonia is most usually associated with bacterial or viral infection but may be caused by inhalation of refluxate from the stomach. This is known as aspiration pneumonia.

Pneumonia is an inflammatory condition of the lungs primarily affecting the air sacs (alveoli).

Aspiration pneumonia usually infects the upper back part (posterior apex) of the lower lobe of the right lung though if lying down it can also infect the back of the upper lobes as well.

Pneumonia is usually treated with antibiotics but for chronic aspiration pneumonia, other treatments may also be considered including intubation (insertion of a tube into the airways) and physiotherapy which may include being taught Active Cycle of Breathing Technique (ACBT) to help clear the lungs.

Pneumonia can cause Bronchiectasis.

COPD  (Chronic Obstructive Pulmonary Disease) and asthma.

Damage to the airways from particles in the air (eg smoke) or aspirated from reflux, can cause a narrowing of the bronchioles or blocking from mucous making exhaling difficult.

On the left is a diagram of the lungs and airways with an inset showing a detailed cross-section of normal bronchioles and alveoli. On the right are lungs damaged by COPD with an inset showing a cross-section of damaged bronchioles and alveoli.

"This retrospective study [Elucidating the Link: Chronic Obstructive Pulmonary Disease and the Complex Interplay of Gastroesophageal Reflux Disease and Reflux-Related Complications, published July 2023 in Medicina], utilizing information from a large national database, was designed to evaluate if individuals with COPD had a greater risk of developing GERD. Secondarily, we intended to analyze the relationship concerning COPD and complications of GERD, including Barrett’s esophagus without or with dysplasia, esophageal cancer, and esophageal stricture."

It concluded, "this population-based analysis provides evidence of a significant correlation between gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD), as well as several secondary related reflux complications." and "The findings underscore the significance of recognizing GERD as a comorbidity in individuals with COPD and emphasize the need for increased awareness regarding the potential consequences of GERD-related complications on their overall well-being. Healthcare professionals should be vigilant in monitoring and managing GERD symptoms in COPD patients, as early intervention and treatment may help mitigate the risk of developing severe reflux-related complications."

This 2014 article from Gastroenterology and Hepatology, "Insight Into the Relationship Between Gastroesophageal Reflux Disease and Asthma" looked at the possible causes.

Here are some key quotes:

Gastroesophageal reflux and asthma are often encountered together, and complex interactions occur during which GERD may increase asthmatic symptoms or asthma may trigger or worsen GERD.

Pathophysiologically, asthma may predispose an individual to the reflux of gastroduodenal contents into the esophagus by a variety of mechanisms, including the following: increased intrathoracic pressure, vagus nerve dysfunction, altered diaphragmatic crural function, and decreased lower esophageal sphincter.

GERD-induced aspiration or microaspiration of gastroduodenal agents may increase airway resistance.

The diagnosis of GERD-related asthma based on the presence of symptoms of heartburn or regurgitation is difficult because patients with asthma do not always have these classic symptoms of GERD.

From Elevated Saliva Pepsin Concentration as a Risk Factor for Asthma in Children with Allergic Rhinitis: A Preliminary Study (Dove Press 2024)

GERD has been considered as a possible risk factor for childhood asthma.1,2 However, the mechanisms were not fully explored; some attributed it to the direct noxious effects of gastric contents in the tracheobronchial tree, while others demonstrated that reflux into the esophagus might activate a neural reflex arc through the vagus nerve, indirectly leading to asthma-related symptoms. Additionally, a preliminary clinical study has suggested the coexistence of both mechanisms.3 The findings of the present study could provide robust evidence supporting the first mechanism, given that pepsin A is an enzyme exclusively produced by gastric chief cells. Its presence in upper airway secretions may be considered as a marker of reflux 

Page update 22 April 2024