Differentiating Between Asthma and Acid Reflux

Dear Ask The Doctor: How can a doctor determine if your chronic cough is asthma or acid reflux? Allergies, activity, laughing, cold or too warm temperatures trigger my coughing, I can't even drink anything too cold. Many things set off my coughing When I go to the emergency room the shot and breathing treatment, and the prednisone treatments put me back on track, but I had a doctor tell me "it's acid reflux".I cough all the time, but the really bad times is when I know I am having a attack and I go to the ER. I do have acid reflux.

Dear Jo: Asthma is a condition of reversible airway obstruction. This can be diagnosed by > 20% variability in peak flow measurements. If you have known acid reflux, it may cause a condition known as reflux laryngitis. The symptoms can include: chronic cough, globus sensation (lump in the throat), chronic laryngitis, hoarseness and difficulty swallowing. The treatment for this is medication to decrease acid production with medications such as proton pump inhibitors or H2 receptor blockers. I suggest attending your family doctor, for a full history and clinical examination. He may prescribe a peak-flow meter and refer you for pulmonary tests with reversibility to help diagnose asthma, or he could prescribe a trial course of  acid reducing medication to assess symptom relief.

To answer your question, the two conditions, if presenting with similar symptoms and history would best be diagnosed by a trial of inhalers or a trial of acid reflux medications and then observe which one treats the symtoms better.  Alternatively, some doctors start patients on both medication and then stop one of them to see which one is most likely providing the benefit.