Airway reflux as a cause of respiratory disease

Reflux is the cause of much respiratory disease. More commonly still, it is the unrecognised agent provoking the symptoms of respiratory disease. That the reflux entering the airways from the gastrointestinal tract is central to the diagnosis, therapy and understanding of respiratory pathology has been missed because the paradigm of peptic disease has been applied. Airway reflux is however unlike gastro-oesophageal reflux disease (GORD). GORD is liquid acid reflux causing heartburn and indigestion. Airway reflux consists of a mainly gaseous non-acid mist which, when deposited in the upper and lower airways leads to inflammation, fibrosis, bronchoconstriction and cough. Here, the hypothesis that airway reflux is responsible for chronic "idiopathic" cough, late onset asthma, exacerbations of COPD, 'idiopathic' pulmonary fibrosis and even the lung disease of cystic fibrosis is outlined. The exclusive focus of clinicians on the extrinsic origins of these conditions and the rejection of an obvious intrinsic aetiology causes millions of patients to be denied an explanation for their symptoms and simple, effective, treatments. In many cases idiopathic should be no longer considered idiopathic