Is GERD the cause of your chronic cough? It's one of many possibilities
Q: I have developed an episodic but chronic cough. My wife thought it could be due to my acid reflux. Is that a real thing?
A: We cough to protect our airway or because something irritates the airway.
The most common cause of an occasional cough is an infection. This is most commonly an upper respiratory infection (URI, i.e. a "cold") due to a virus, and these are usually self-limited. It is common for an URI to last a week or two, and occasionally it will last even longer. Typically, a person will get a cold three or four times a year. Smokers, or patients with underlying lung disease, may have more pronounced symptoms.
Other infections that can cause coughs include bronchitis or pneumonia. Although most cases of bronchitis (an infection a bit deeper down in the lungs than an URI, since it also involves the bronchi) are also viral, some can be due to bacteria (especially in smokers or people with other underlying lung diseases). Pneumonia (an even deeper infection than bronchitis and involving the lung parenchyma) can be due to a virus, but bacterial infections deep in the lungs are not uncommon.
A foreign body getting into the airway (e.g., "the food went down the wrong pipe") and reactions to airborne or other irritants (such as to smog, chemicals in the air, etc.) can also cause a cough.
More chronic coughs are caused by more chronic conditions, including asthma, allergies, post-nasal drip (for example from sinus issues or other causes) or other causes.
Gastro-esophageal reflux disease (GERD) is when stomach acids flow back up through the lower esophageal sphincter (LES) into the esophagus. Unlike the cells in the stomach, which are specially designed for an acid environment, the esophagus may be negatively affected by the presence of acid. GERD is a common condition, with 10% to 20% of the U.S. population having it to some extent.
Symptoms from GERD may include a burning or painful feeling in the chest (often referred to as heartburn) and, yes, it can also cause an episodic, chronic cough (particularly triggered when the GERD is triggered, for example when lying flat to sleep after a big meal).
Anatomically, the esophagus (the "food pipe") and trachea (the main tube that begins the airway) run parallel as they leave the oropharynx (the back of the throat). This close proximity may allow for multiple interactions between these two structures, and indeed there are several theories as to how GERD may stimulate coughing:
Some of the acid that passes through the LES into the esophagus may make its way all the way up to the oropharynx (in fact, many patients with GERD notice an acid taste in their mouth from time to time). From here some of the acid can leak into the trachea and even down to some of the smaller airways. This direct irritation of the airway from aspirated acid may cause a cough, and over time even some inflammation (possibly leading to "asthma-like" symptoms such as wheezing, etc.).
Over-stimulation of the vagus nerve, which in turn triggers airway constriction.
Inflammation of the voice box area (the larynx and surrounding structures) from chronic acid reflux causing a feeling of "needing to clear your throat" and, hence, coughing.
Although a cough caused by GERD is a diagnosis of exclusion (that is, other causes of the cough are determined not to be likely), especially if you have 1.) GERD symptoms, 2.) your cough is worse at night, 3.) your cough is worse after eating and/or 4.) your cough is worse when lying flat, GERD as a cause of your cough should be considered.
A reasonable next step in many patients with a chronic cough thought to possibly be due to GERD is to begin treatment for GERD to see if symptoms improve, including the cough. It may be necessary to look more closely to see if acid is traveling up past the LES by doing a pH study; this is done by placing a special pH measuring device through the nose and down into the esophagus where it can continuously measure the pH over 24 hours or so.
Bottom line, you should discuss this with your primary care physician, and decide the best next steps for you to diagnose and treat your concerns.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: Dr. Jeff Hersh: Chronic cough could be caused by infections or GERD
