—We are gratified by the comments and intriguing speculation offered in the letters of Umeki and Maddox. It is interesting to note that Umeki suggests the possibility that the asthma therapy may directly affect gastrointestinal tract symptoms and that Maddox suggests that the gastrointestinal tract therapy may directly affect the asthma. This serves to illustrate the complex causal and management interrelationships between these two conditions.
Recent evidence concerning the late asthmatic reaction1 has emphasized that asthma is not only a bronchoconstrictive disease, but usually an inflammatory disease as well. If reflux-associated asthma (RAA) involves microaspiration or macroaspiration of refluxed acidic material, inflammation of the tracheobronchial mucosa is likely to be an important aspect of this condition. Systemic steroidal therapy may be expected to reduce the tracheobronchial inflammation and similarly decrease the bronchial hyperreactivity of RAA. Esophagitis, grossly and microscopically, was observed in a large proportion of our patients. Although we