6.7. Reactive Airways Disease In patients with asthma who also have heartburn, reflux may be a contributing factor to the asthma. Despite a high frequency of abnormal reflux studies in patients with asthma who do not have heartburn, there is no strong evidence to support empiric PPI therapy in unselected pediatric patients with wheezing or asthma. Only 3 groups—those with heartburn, those with nocturnal asthma symptoms, and those with steroid-dependent difficult-to-control asthma—may derive some benefit from long-term medical or surgical antireflux therapy. Finding abnormal esophageal pH exposure by esophageal pH monitoring, with or without impedance, before considering a trial of long-term PPI therapy or surgery may be useful, although the predictive value of these studies for this purpose has not been established. The relative efficacy of medical versus surgical therapy for GERD in children with asthma is unknown.