Coughing and Acid Reflux - dummies

By Patricia Raymond, Michelle Beaver

Coughing may not sound like a big deal. Everyone coughs from time to time. Yes, it can hurt and make your throat feel raw and dry, but it’ll feel better in a few days, right? Unfortunately, this is not the case for many people with acid reflux–related coughs.

First, the discomfort and irritation that results from constant coughing can be more severe. This makes sense because your throat may already be irritated, inflamed, or damaged by stomach acid and enzymes that have splashed up.

Second, many people with reflux-related coughs have what is known as a chronic cough. Chronic coughs are persistent. It’s something that you’ll have to deal with every day, and unfortunately for many people, it won’t go away anytime soon, maybe ever. Although some patients have been lucky enough to eliminate a chronic cough with treatment, many others haven’t.

Imagine not being able to sleep because your cough keeps waking you up. Imagine not being able to go to the movies or out to a nice restaurant because you’re worried that your constant coughing is going to ruin the experience for others.

Or imagine what it must feel like to have people stare at you, wondering what illness you have that is making you cough so much, and whether you’re contagious. Maybe all this is the case for you, and you don’t have to imagine at all.

Not every chronic cough is the result of acid reflux, but between 20 percent and 40 percent of chronic coughs are believed to be related to acid reflux or gastroesophageal reflux disease (GERD). There are two primary reasons why acid reflux causes coughing.

The first reason is due to stomach acid itself; if even a small amount of stomach acid reaches the larynx or gets into the lungs, it can trigger a coughing spell. The other reason is due to automatic reflexes, which developed as the digestive track evolved; a little bit of reflux in the esophagus can trigger an automatic reflex that induces coughing.

One significant issue that physicians face is being able to diagnosis chronic cough as a result of acid reflux. Although it’s possible to have symptoms like heartburn, many patients with reflux-related chronic coughs do not experience the more common symptoms of reflux. Because a patient may not be experiencing other reflux symptoms, it’s quite easy for her doctor to overlook reflux as a potential cause.

There are two primary ways in which your doctor will try to verify that a cough is the result of reflux:

  • pH testing: This procedure allows physicians to verify that stomach acid is making it into the top portion of the esophagus and can help quantify the severity of the reflux and the association between reflux episodes and cough.

  • Proton pump inhibitor (PPI) therapy: In this test, you’ll be given high doses of PPIs (drugs that reduce gastric acid production) while your cough symptoms are monitored for up to three months. If your cough improves during this time, you’ll likely be diagnosed with a reflux-related chronic cough.