The small airways are softer, fleshy, and react a lot like the inside of the nose. Asthma usually starts here and often produces congestion, thick mucous that plugs these passages. This is very significant since the best treatment should target these areas. Certainly the symptoms and distress of asthma involving only the small airways are less than more extensive disease but these changes should never be ignored since if left untreated, the small airways disease may become chronic and fixed. More and more studies show a close connection between GERD and asthma.
GERD patients are often asthmatics and vice versa.
The exact mechanism is not clear despite a lot of research. This definitely can excite an asthma attack. It is also clear that effective treatment of GERD can improve some asthmatic patients in terms of how many attacks, especially nocturnal attacks that they experience. It is also a major cause of cough and even laryngitis. What is very striking to me is how silent this may be.