Gastroesophageal reflux disease (GERD) can cause a chronic cough when stomach contents, including acid, reflux into the esophagus and irritate the throat or airways. This irritation can result from direct contact with the respiratory tract or a reflex mechanism. This chronic cough, termed GERD-related chronic cough (GERC), is a common cause of persistent coughing, even without typical heartburn symptoms, and can significantly affect quality of life.
Medications for GERD Cough
Managing a GERD cough involves addressing acid reflux with medications that reduce stomach acid production or provide a protective barrier. Antacids offer immediate, temporary relief by neutralizing existing stomach acid. These over-the-counter options quickly alleviate symptoms, but their effects are short-lived.
For more sustained relief, histamine-2 receptor antagonists (H2 blockers) reduce acid produced by stomach lining cells by blocking histamine. Common H2 blockers include famotidine (Pepcid AC) and cimetidine (Tagamet HB), available over-the-counter and by prescription. These medications typically reduce acid production within one to three hours, providing several hours of relief.
Proton pump inhibitors (PPIs) are potent acid reducers effective for chronic GERD symptoms, including cough. PPIs inhibit “proton pumps” in the stomach’s parietal cells, significantly reducing acid production. Common PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), and esomeprazole (Nexium). PPIs offer more profound and prolonged acid suppression than H2 blockers, making them a common choice for persistent GERD.
Alginates form a physical barrier over stomach contents. They react with stomach acid to create a gel-like raft that floats on top of the gastric pool, preventing acid from flowing back into the esophagus and airways. Alginate-based formulations can control acid exposure and alleviate reflux symptoms. Consult a healthcare professional before starting any new medication.
Lifestyle Adjustments to Alleviate Cough
Beyond medications, various lifestyle adjustments can significantly reduce GERD symptoms and the associated cough. Modifying dietary habits involves identifying and avoiding trigger foods that can worsen reflux, such as fatty foods, spicy foods, caffeine, chocolate, citrus fruits, and peppermint. Consuming smaller, more frequent meals instead of large ones can also help reduce pressure on the stomach and minimize reflux.
Changing eating patterns is another important adjustment. It is recommended to avoid eating close to bedtime, allowing two to three hours between the last meal and lying down. This practice gives the stomach time to empty, reducing acid reflux during sleep.
Postural changes during sleep can provide relief. Elevating the head of the bed by six to eight inches helps gravity keep stomach acid in its proper place. This can be achieved using bed risers under the head of the bed or a wedge pillow. Simply using extra pillows under the head is often not effective, as it may only elevate the head and neck without adequately raising the entire upper body.
Managing body weight is beneficial, as excess weight, particularly around the abdomen, can increase pressure on the stomach. This pressure can force stomach contents back into the esophagus, exacerbating reflux. Losing even a small percentage of body weight can significantly reduce GERD symptoms.
Smoking cessation is recommended for individuals with GERD. Smoking weakens the lower esophageal sphincter (LES), increases stomach acid production, and reduces saliva that neutralizes acid. Quitting smoking can lead to a marked improvement in GERD symptoms. Additionally, wearing loose-fitting clothing, especially around the waist, alleviates abdominal pressure and helps prevent acid reflux.
When to Seek Professional Medical Advice
While lifestyle changes and over-the-counter medications can provide relief, it is important to seek professional medical advice for a GERD cough in certain situations. If the cough or other GERD symptoms persist despite consistent use of over-the-counter treatments and lifestyle adjustments, a healthcare professional should be consulted. This persistence may indicate a need for stronger prescription medications or further diagnostic evaluation.
It is particularly important to seek medical attention if new or worsening symptoms emerge. These include difficulty swallowing (dysphagia), painful swallowing (odynophagia), unexplained weight loss, black or bloody stools, or chest pain. These symptoms could indicate more serious underlying conditions that require immediate medical assessment.
A doctor can also help differentiate a GERD cough from other causes of chronic cough. Many conditions, such as asthma, postnasal drip, or certain medications, can cause a persistent cough. A comprehensive evaluation can help pinpoint the exact cause and ensure appropriate treatment.
For a chronic condition like GERD, professional guidance is important for long-term management and to prevent potential complications. Untreated or poorly managed GERD can lead to issues such as esophagitis (inflammation of the esophagus), esophageal strictures, or Barrett’s esophagus, which is a risk factor for esophageal cancer. A healthcare provider can develop a tailored treatment plan, monitor progress, and adjust therapies as needed to maintain symptom control and minimize health risks.