IN or OUT? The Billion Dollar Medical Mistake (Per Week!)

According to the Centers for Disease Control, 8% of all Americans and 17% of poor, non-white children in the U.S. have asthma. Asthma-related costs including doctors, hospitals, and medication add up to $56 billion per year. But what if doctors had it wrong? What if asthma was one of the most common misdiagnoses in America? What if the real problem was actually “silent” acid reflux and not asthma at all?

If you or someone you know has a diagnosis of asthma, you must carefully consider this very important question: When you have trouble breathing during an “asthma” attack, do you have more difficulty getting air IN or OUT? Trouble getting air IN (during inhalation) is NEVER asthma, while trouble getting air OUT (during exhalation) is.

How does this work? The difference between breathing IN and OUT is explained by the anatomy and physiology of the airway. With acid reflux, airway obstruction occurs at the level of the larynx (voice box). The upper part of the larynx contains acid receptors, which act like electrical switches. When triggered by exposure to acid, these receptors close the vocal chords. That results in trouble breathing IN. This type of airway obstruction is similar to that seen in children with croup or whooping cough, who may make loud, crowing sounds when breathing IN.

The mechanism of airway obstruction in asthma is completely different. People with asthma have trouble getting air OUT, because the breathing tubes in the lungs (inside the chest cavity) are narrowed, usually due to an allergic reaction. Consequently, during exhalation (breathing OUT), the full lungs exert additional pressure on the already narrowed bronchial tubes, resulting in prolonged expiration, what we hear as wheezing.

Decades of combined medical practice focused on patients with acid reflux, has informed three key observations: (1) Approximately 80% of patients with asthma don’t have it; (2) Silent reflux (acid reflux occurring without the obvious symptoms of heartburn or indigestion) is usually the correct diagnosis, and (3) A problem breathing IN is never asthma. Indeed, people with wrongfully diagnosed asthma, the INs, don’t respond to asthma treatments, but they do get well when their reflux is adequately controlled.

Remember: Reflux affects the throat and causes trouble breathing IN. Asthma affects the lungs and causes trouble breathing OUT. Unfortunately, this important clinical point is not understood by most doctors. Only when everyone is aware of this fact will the over-diagnosis of asthma cease, resulting in better health for millions of people, along with overall savings in the billions of dollars.

– Jamie Koufman, M.D.

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