CHRONIC Obstructive Pulmonary Disease (COPD) is a consortium of various progressive lung diseases, including chronic bronchitis, refractory (non-reversible asthma), and emphysema, characterized by increasing shortness of breath. About 24 million people in the United States have COPD and its ranks third as the most common cause of death.

    COPD is an increasing health threat across the globe. There are many known causes or contributing factors in the development of COPD or COLD (Chronic Obstructive Lung Disease). Among them are smoking, second-hand smoke, chemical dust at workplace, air pollution, fumes from cooking, genetic defect with Alpha 1 trypsin deficiency at birth, history of asthma, low birth weight, and poor nutrition. At this point, I would like to add Gastro-Esophageal Reflux Disease (GERD).

    It didn’t dawn on me that GERD could cause COPD until my daughter Sheillah C. Gentile, MD, doing family medicine in Munster, Indiana, pointed out that many patients with GERD later developed COPD.

    What is GERD?

    Gastro-Esophageal Reflux Disease is a condition which allows stomach hydrochloric acid (normal chemical which aids in digestion, together with gastric enzymes) to go back up from the stomach to the esophagus (food pipe) among individuals who have an incompetent (loose) Gastro-esophageal valve. Normally, this valve between the stomach and the esophagus closes air-water tight. In some persons, the valve becomes loose and unable to prevent acidic fluid and fumes from going back up (reflux) to the esophagus and even up to the throat area, and drips or flows into the wind pipe and into the lungs.

    Chronic acid reflux eventually leads to GERD. The acid gradually burns the lung tissue and over time a significant area of the lungs is damaged, unable to oxygenate the entire body adequately. This is when shortness of breath starts.

    How prevalent is GERD?

    GERD is a common disorder, many not even realizing they have it. About 18.1 to 27.9 percent of Americans have GERD, 8.8 to 25.9 % in Europe, 2.5 to 7.8 % in East Asia, 8.7 to 33.1 % in the Middle East, 11.6 %in Australia, and 23 % in South America. Most patients complain of burning discomfort in the pit of the stomach after meals, or at night, while lying down, allowing stomach acid to flow back to the esophagus. Many times, the burning disappears when the person gets up. The symptom could also be that of a sense of indigestion or “sour stomach.” People who take antacids, like Alka Seltzer, Maalox, Tums, etc. could have GERD.

    What are the other symptoms?

    When reflux of stomach acid (liquid gastric juice or acid fumes) happens, the person might feel something in the throat and coughs a little. This is especially true when the patient lies down flat after eating or drinking. In this recumbent position, it is very easy for fluid to flow from the stomach to the food pipe. Hence, bed elevation is one of the treatments for GERD.

    The acidic (bitter) taste we sometimes experience is due to acid reflux. Heartburns are also symptoms of GERD because, while the stomach produces acid and is used to an acidic environment, the esophagus is not and cannot tolerate acid. This is why untreated reflux causes inflammation of the lower end of the food pipe (esophagitis), which in the long run could cause scarring, stricture and blockage of the lower end of the esophagus. Other potential complications are esophageal ulcer, hemorrhage, Barrett’s metaplasia, cell changes in the esophagus that could transform to cancer. If GERD is not treated aggressively, there are also collateral damages to the lungs from acid reflux which will lead to COPD.

    What is the treatment for GERD?

    Surgery to make the GE valve competent was popular in the past, including repair of Hiatal Hernia, but the controlled study in Sweden termed LOTUS (Long-Term Usage of Acid Suppression Versus Anti-reflux Surgery) reported in the journal GUT in September 2008, showed that the Proton Pump Inhibitor (PPI) drug esomeprazole (Nexium) was equally effective, if not more, than surgery. The other PPI drugs are omeprazole (Prilosec), Lansoprazole (Prevacid), dexiansoprazole (Dexilant), rabesprazole (Aciphex), pantoprazol (Protonix). Elevation of the head of the bed to prevent back-up of acid from the stomach to the foodpipe and windpipe, avoidance of spicy foods, alcohol, tobacco, wearing loose pajamas, and waiting for at least 3 hours after a meal to go to bed, are parts of the management of GERD. A regular visit with the gastroenterologist is also important to rule out any serious pathology in the GI tract.

    Is sleep apnea commonly seen in persons with GERD?

    Obstructive Sleep Apnea (OSA) is an anatomical blockage in the upper airway, which makes the person hold his breath for an abnormally long period of time, depriving the individual of oxygen, and then suddenly wake up gasping for breath. Some people never woke up, dying from heart attack due to prolonged lack of oxygen. While many OSA patients are snorers, not all snorers have OSA. The chronic lack of sleep and oxygen deficiency among these patients make them feel very tired, irritable, unfocused, less productive, forgetful, and are prone to develop major illnesses, including cancer. OSA must be treated as soon as possible with CPAP (Continuous Positive Airway Pressure) machine for a restful sleep every night.

    Studies show that a relationship exists between Obstructive Sleep Apnea (OSA) and GERD, with 60 percent of OSA patients also having GERD, which has a dramatic health effect on sleep. The risks include: aspirating (breathing into the wind pipe and to the lungs) stomach acid or acid fumes while asleep, aggravating sleep apnea and disturbing sleep with interruptions due to the heartburns.

    What is the treatment for sleep apnea?

    There are about 22 million Americans with OSA, as many as 80 percent undiagnosed. Since untreated Sleep Apnea could lead to many cardiovascular (high blood pressure, heart attack, stroke), metabolic (diabetes T2, thyroid conditions, etc.), and even cancerous illnesses as complications, an early and aggressive treatment with CPAP is prudent. Those advertised on television, from nose tapes or clips, mouthguard, pills, and potion to take, are all false and a scam. Those makers and vendors of these dangerous products of deception (that leads to delay in the diagnosis and treatment, must be held legally liable for eventual complications). They are not treating the anatomical/physiological cause of OSA (the mechanical obstruction in the upper airway passage) and are marketing their products that give false sense of security and endanger the lives of the unsuspecting ignorant gullible public, all for greed. Indeed: caveat emptor!

    The Department of Justice ought to execute its obligation under the law to protect the public.

    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States.

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