Catching a cold is a common complaint during winter months; it’s not unusual to spend at least a few days between November and March sick in bed with a bad cough or sore throat. But if those symptoms persist all season (and well into the spring) they may be signs of a more chronic condition, like acid reflux or its more severe form, gastroesophageal reflux disease (also known as GERD).
Many people think of heartburn and stomach pain when they think of acid reflux, but the condition can rear its ugly head in other ways, as well. Here’s how to know if your chronic cough could be a symptom, and, if so, how to get your GERD under control.
What Is Acid Reflux, Anyway?
Acid reflux, also called gastroesophageal reflux, occurs when stomach acid flows the wrong way from the stomach back up into the esophagus. “The valve between the esophagus and the stomach — the sphincter valve — becomes weakened or damaged,” explains Walter Coyle, MD, head of gastroenterology at Scripps Clinic Torrey Pines in La Jolla, California. “When pressure is put on it, it has trouble staying closed and keeping that acid in the stomach where it belongs.”
For many people, reflux only occurs infrequently — after eating spicy foods or large, fatty meals before bed, for example. Avoiding those triggers, or taking an over-the-counter acid blocker like Tums, can usually treat these cases. But for others, acid reflux progresses to GERD, a chronic condition that occurs at least twice a week and may require medication or more comprehensive lifestyle changes.
Episodes of reflux are usually accompanied by a sour taste in your mouth or a burning sensation in your chest. But it’s important to note that not everyone experiences these obvious symptoms.
“You can also have silent GERD, which does not have the classic burn you see in commercials on TV,” Coyle says. Women, diabetics and older adults are more likely to experience silent GERD, and may have less obvious symptoms like a chronic cough, sore throat, hoarseness, or trouble swallowing.
The Cough Connection
There are many possible explanations for a cough that lasts longer than a typical cold or upper respiratory infection, Coyle says. Usually allergies, asthma, cigarette smoking, or post-nasal drip is to blame. But acid reflux sometimes plays a role, as well.
Studies have suggested that at least 25 percent of chronic couch cases are “associated with GERD,” but experts caution that this doesn’t mean reflux is always the cause. Because GERD is so common — it affects about one in five Americans — it’s difficult to determine whether it is responsible for a person’s chronic cough or if they are unrelated.
But even if there’s no direct connection, Coyle says, frequent reflux can definitely make a chronic cough caused by something else even worse. “If you’ve been coughing consistently for more than three weeks, or if every time you lie down or overeat or exercise you start coughing, GERD is definitely something you should be screened for,” he says.
Reflux can cause or exasperate coughing in two ways: In some cases, the acid flowing backward in the esophagus stimulates a reflex, causing a person to persistently cough or clear his or her throat. This happens most often when lying down, after a large meal, or after intense exercise.
In others cases, reflux causes the aspiration of tiny food particles in the laryngopharynx (where the throat connects to the esophagus), causing coughing and trouble swallowing. This type of reflux, known as extraesophageal GERD or laryngopharyngeal reflux (LPR), is typically the “silent” type that lacks traditional heartburn symptoms. It’s estimated that as many as 75 percent of people with chronic cough experience this type of silent GERD.
Treatment and Prevention
Screening for GERD can be done with one of two tests: A 24-hour PH test, in which a probe is inserted through the nose and worn for one day; or a 48-hour Bravo test, where a capsule is placed into the esophagus for two days. Both of these can determine whether you are experiencing reflux and when your symptoms occur.
Serious cases of GERD may require surgery, but luckily, mild to moderate reflux is almost always treatable with lifestyle modifications or medications. Losing excess weight and quitting smoking are two of the most effective ways to lessen or eliminate GERD symptoms. If they don’t apply to you, says Coyle, pay attention to when your symptoms happen, and experiment with taking an over-the-counter antacid before you eat those foods or do those activities.
“If you cough every time you exercise, for example, and you don’t have a history of asthma or lung disease, try taking an antacid right before exercise,” he suggests. “If you find that it helps, talk to your doctor about getting on a prescription medication.” (Prescription drugs are generally better for long-term use, he says, while over-the-counter pills are better for short-term or occasional treatment.)
Frequent earaches, sore throats, difficulty swallowing, or waking up regurgitating or up choking on food at night — with or without a chronic cough — may also indicate that you have GERD. If you experience any of these symptoms regularly, talk to your doctor about whether an acid reflux medication may be worth a try.