Gastroesophageal Reflux Disease (GERD) is a common digestive condition where stomach acid frequently flows back into the esophagus. While often recognized by heartburn and regurgitation, a persistent cough can also indicate GERD. This chronic cough affects daily life and sleep. Understanding the connection between GERD and this cough, along with management strategies, can help alleviate discomfort.
Why GERD Causes a Cough
A chronic cough associated with GERD stems from irritation caused by stomach contents refluxing into the esophagus. This irritation triggers a cough reflex through two mechanisms.
The first mechanism involves a reflex. The vagus nerve is stimulated when stomach acid rises into the esophagus, signaling the brain to initiate a cough to clear the irritant.
The second mechanism is microaspiration. Tiny droplets of stomach contents are inhaled into the airways. Even minute amounts irritate the respiratory tract, causing inflammation and a cough. This irritation can occur without noticeable heartburn, known as “silent reflux” or LPR (laryngopharyngeal reflux). Constant exposure to stomach contents can also sensitize the airways, making them more prone to coughing.
Everyday Changes for Cough Relief
Adjusting daily habits reduce GERD symptoms and related coughing. Dietary modifications involve avoiding trigger foods that relax the lower esophageal sphincter or increase stomach acid. Common culprits include acidic foods like citrus and tomatoes, spicy dishes, fatty foods, chocolate, caffeine, and peppermint. Focusing on a diet rich in fruits, vegetables, and whole grains help neutralize acid and improve digestion.
Changing eating habits supports cough relief by minimizing reflux. Eating smaller, more frequent meals prevents the stomach from becoming overly full and pressuring the lower esophageal sphincter. Avoid eating for at least two to three hours before lying down, allowing digestion. Chewing food thoroughly and eating slowly aids digestion and reduces reflux.
Positional changes, particularly during sleep, use gravity to reduce reflux. Elevating the head of the bed by 6 to 8 inches helps keep stomach contents from flowing back overnight. This is best achieved using a foam wedge or blocks under bedposts, rather than just stacking pillows. Maintaining an upright posture after meals is helpful, as slouching can promote acid backflow.
Weight management plays a role in alleviating GERD symptoms, especially for individuals with excess weight. Increased abdominal pressure from extra weight forces stomach contents upward, exacerbating reflux. Even modest weight loss reduces this pressure and improves GERD symptoms, including cough. Low-impact exercises like walking or yoga support weight loss and digestion.
Reducing or eliminating smoking and alcohol consumption contributes to cough relief. Smoking weakens the lower esophageal sphincter and increases stomach acid production. Alcohol irritates the esophageal lining and stimulates acid production. Quitting smoking and moderating alcohol intake helps restore proper esophageal sphincter function and reduces irritation.
Stress management techniques indirectly benefits GERD-related cough by reducing physiological responses that worsen reflux. Stress heightens the perception of GERD symptoms, promotes inflammation, and impacts digestive processes. Incorporating practices such as deep breathing, meditation, or yoga help calm the nervous system and alleviate symptoms.
Medical Treatments for GERD Cough
When lifestyle adjustments are insufficient for a GERD-related cough, over-the-counter (OTC) and prescription medications exist. These primarily reduce stomach acid, minimizing irritation. Healthcare providers often recommend a stepped approach, starting with less potent options.
Antacids
Antacids, such as those containing calcium carbonate, aluminum hydroxide, or magnesium hydroxide, offer quick, temporary relief by neutralizing stomach acid. Suitable for occasional, mild symptoms, not chronic management. Antacids do not address the underlying cause of reflux or heal esophageal damage.
H2 Blockers
H2 blockers, or histamine-2 receptor antagonists, reduce acid production by blocking histamine’s action on stomach cells. Famotidine is one such medication. H2 blockers provide longer-lasting acid suppression than antacids, typically for several hours, used for more frequent symptoms. Available over-the-counter and in higher prescription strengths.
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors (PPIs) are the most potent class of acid-reducing medications, blocking acid production at proton pumps in stomach cells. Common PPIs include omeprazole and lansoprazole. PPIs are effective for consistent acid suppression, often prescribed for moderate to severe GERD and chronic cough. Consistent use, typically once daily before a meal, is important for their full effect. Consult a healthcare professional for personalized advice on medication choice, dosage, and potential side effects.
When to Consult a Doctor
Seeking professional medical advice is important if a cough persists despite lifestyle changes and over-the-counter medications. A chronic cough lasts eight weeks or longer. While GERD can be a cause, other conditions like asthma, postnasal drip, or respiratory infections present with similar symptoms. A healthcare provider can accurately diagnose the underlying cause.
Certain accompanying symptoms warrant prompt medical evaluation. These include difficulty swallowing, unexplained weight loss, chest pain, choking, or coughing up blood. Such symptoms could indicate more serious GERD complications, like esophageal damage or strictures, or point to other health concerns. If there are concerns about medication side effects or if current treatments are not providing adequate relief, a doctor can adjust the treatment plan.