The acid destroys the barrier to bacterial infection, and together with the prednisone
the patient becomes prone to a sore throat
, and infection which may rapidly progress to the lung.
Thus, the drill is, when on high-dose oral predisone, avoid esophageal acid erosion. I don't know why this information is not widely known.
This is accomplished by:
(a) not eating within two hours of sleeping.
(b) avoiding foods that contain methylxanthines (chocolate), which relax the sphincter.