A dry cough can stem from various sources, and acid reflux is a potential, often overlooked, cause. This article explores the connection between acid reflux and dry cough, explaining how this gastrointestinal condition can manifest as a respiratory symptom.
Understanding Acid Reflux
Acid reflux occurs when stomach acid flows backward into the esophagus. This happens due to a weakened lower esophageal sphincter (LES), a circular band of muscle at the bottom of the esophagus that normally closes to prevent stomach contents from returning. When the LES does not close correctly, stomach acid can back up, irritating the esophageal lining.
The most common symptom is heartburn, a burning sensation typically felt in the chest. Another frequent symptom is regurgitation, the backwash of food or sour liquid into the throat or mouth. Chronic acid reflux, occurring at least twice a week, is diagnosed as gastroesophageal reflux disease (GERD).
How Reflux Triggers a Dry Cough
Acid reflux can trigger a dry cough through two primary mechanisms. First, direct irritation of the throat and airways occurs when stomach acid travels up the esophagus. This acid can irritate the lining of the throat, larynx (voice box), and potentially the airways if small amounts are inhaled (microaspiration). This irritation leads to inflammation and a persistent, dry cough.
Second, a nerve reflex can cause a cough. Even without acid physically reaching the upper airway, its presence in the lower esophagus can stimulate the vagus nerve, triggering a protective cough reflex. This reflex is thought to be an early protective mechanism to prevent stomach contents from entering the lungs.
Identifying Reflux-Related Cough
A cough linked to acid reflux commonly worsens at night or when lying down, and after meals, particularly large or fatty ones. This type of cough typically does not respond to common cough suppressants or cold remedies.
Other symptoms of acid reflux may accompany the cough, including hoarseness, a chronic sore throat, or a sensation of a lump in the throat (globus sensation). Excessive throat clearing is also common. If a persistent cough lasts for eight weeks or longer without a clear cause, consult a healthcare professional to rule out acid reflux or other conditions.
Managing Reflux-Associated Cough
Managing a dry cough linked to acid reflux involves reducing the reflux itself. Lifestyle adjustments can help alleviate symptoms. These include avoiding trigger foods like spicy or fatty items, caffeine, and alcohol. Eating smaller, more frequent meals and avoiding lying down for at least three hours after eating are also beneficial.
Elevating the head of the bed by six to nine inches uses gravity to keep stomach acid in place during sleep. Maintaining a healthy weight can also reduce pressure on the stomach and the LES, minimizing reflux.
Over-the-counter options like antacids can neutralize stomach acid for temporary relief. H2 blockers reduce acid production. For persistent symptoms, stronger medications like proton pump inhibitors (PPIs) may be prescribed. These block acid production more powerfully and can help esophageal tissue heal, but should be used under medical guidance.