Our results suggest that aspiration of acidic contents leads to an early immune response (i.e., increased levels of Col-V contained in circulating small EVs and the development of antibodies against Col-V) and a relatively proinflammatory state (i.e., determined by a slight increase of NF-κB contained in EVs), which may provide another pathophysiological explanation of how GERD contributes to chronic respiratory conditions. Here, NFKB1 is linked to gastroesophageal reflux disease.