The association between pulmonary symptoms and gastro-oesophageal reflux has been well documented. However, it is still unclear whether abnormal pulmonary function causes increased reflux or reflux causes pulmonary symptoms. Available data suggest that both theories may be accurate. Clinical features of patients with reflux-induced pulmonary complications have been identified, although there are no specific methods for confirming this diagnosis. An algorithm that defines a series of diagnostic tests is presented. From the results of the small number of published clinical trials, it appears that antireflux surgery is the most effective and longest-lasting treatment for the correction of pulmonary symptoms.