Is there a relation between acidity and coughing?

If you have had a cough for a while, your first guess is probably that you have a respiratory problem. Perhaps it’s a cold, a bacterial infection of the throat, or even Covid-19. Sometimes though, a cough that lasts for more than a few days can have other causes.

Studies and experience of gastroenterologists indicate that a long-term cough may be a sign of chronic acidity, commonly known as GERD (gastrointestinal reflux disease). Acid reflux is a condition when stomach acids back up into the food pipe or the oesophagus. The acid irritates the tissue lining of the oesophagus and causes the tell-tale symptom of heartburn – a sensation of burning in the chest. This irritation from the acid reflux in the throat or breathing in the acid droplets can cause coughing.

Though heartburn is the most common symptom of GERD, coughing is also a symptom. Acid reflux that occurs more than twice a week can lead to GERD. If left untreated, GERD can cause ulcers and permanent damage to your food pipe. It also increases the risk of oesophageal cancer.

GERD and coughing

A cough that lasts longer than 8 weeks is considered chronic. Though chronic coughing is not the most typical sign of GERD, it is associated with at least 25% of cases of chronic coughing with some studies estimating the figure to be 40%.

Chronic coughing can be made worse by acid reflux as well. GERD can cause or worsen coughing in the following ways:

• As stomach acids rise in the food pipe, coughing is triggered as a reflex.
• Droplets of stomach acids can rise up the oesophagus and reach the throat or the voice box, irritating the back of your throat. This kind of reflux is known as LPR (laryngeal pharyngeal reflux). Incidentally, coughing may develop as a defence mechanism against such reflux in an attempt to keep the throat clear of such foreign particles.

Symptoms of GERD-related coughing

Some signs that indicate that your cough may be caused by GERD include:

• Coughing occurs at night or after a meal.
• Coughing occurs or increases when you are lying down.
• Coughing without asthma or post nasal drips.
• Coughing when X-rays are clear, indicating no upperrespiratory congestion.
• Chronic coughing is present when common triggers such as smoking, throat infections, or sideeffects of certain medication are absent.

When should you see a doctor?

A cough associated with GERD or LPR requires attention from a doctor. If your cough persists for more than 3 weeks without improvement, consult your doctor. You should reach out to your doctor sooner if your cough gets worse with time, breathing is becoming difficult, or there is chest pain.

Diagnosis and testing

As we have mentioned earlier, coughing isn’t a typical symptom of GERD. As a result, identifying GERD as the cause of a persistent cough requires specialised tests. Your gastroenterologist may conduct tests to measure pH levels in your food pipe or an endoscopy to make the diagnosis.

Various factors related to your lifestyle may also be considered to determine the risk of GERD-induced coughing, which include:

• Smoking
• Regular consumption of foods that trigger GERD: spicy food, fried and oily food, caffeine, alcohol, garlic, and citrus fruits.
• Excess body weight

Medical treatment

Your gastroenterologist may prescribe you medication to manage episodes of acid reflux as well as to prevent them. Fewer instances of acid refluxes will protect your oesophagus from damage. These prescribed and over-the-counter medications include:

• PPI (proton pump inhibitors) to treat heartburn and ulcers by reducing the production of stomach acids.
• Antacids to manage instances of acid reflux.
• Foaming agents to prevent the contents of the stomach from backing up and causing reflux.

Preventing and improving GERD with lifestyle changes

• Eat smaller meals more frequently.
• Don’t lay down for 2 to 2.5 hours after meals.
• Maintain a healthy body weight (refer to a BMI score of 25 to calculate the appropriate weight for your height)
• Stop or don’t smoke.
• Avoid consuming alcohol.
• Limit consumption of foods that trigger acidity:
  • Spicy foods
  • Oily/ fatty/ greasy/ fried foods
  • Caffeine/ coffee/ tea
  • Citrus fruits
• Elevate the head of your bed by a few inches using inserts to create a slight downward sleeping angle.
• Avoid wearing tight-fitting belts or clothes that apply pressure around your abdomen.

A chronic cough may indicate GERD. Once diagnosed, cough from GERD can be treated easily and without further damage to your food pipe. If you suffer from GERD, you will probably display other symptoms such as hoarseness, heartburn, and trouble swallowing as well. Your doctor will conduct tests to confirm GERD and prescribe medication to manage and treat your condition. Lifestyle behaviours such as avoiding certain foods, not smoking or consuming alcohol, and maintaining a healthy weight can also help prevent GERD.To know if your chronic coughing warrants a deeper investigation and what risks you face, consult the best gastroenterologists in Bangalore at the Department of Gastroenterology and Hepatology in Sagar Hospitals.