Could a GI Condition Be Causing Your Chronic Cough?
Coughs are common. Most of us have experienced viral or bacterial infections, or other acute forms of cough, typically lasting from a few days to a few weeks. However, some individuals experience a cough that doesn’t go away. Chronic cough is defined as a cough that lasts at least eight weeks (four weeks in children) and is not associated with serious symptoms, such as breathlessness, fever, chest pain, and weight loss. The cough could be an ongoing problem that lasts for months or even many years. It occurs most often in middle-aged adults and is more common in women than in men. This type of chronic cough is generally not contagious, but it can be very stressful to deal with, especially during the COVID-19 pandemic, when most people will jump to the conclusion that you are infected with the SARS-CoV-2 virus if they hear you cough repeatedly.
If you experience chronic coughing, you might worry that there is something wrong with your lungs. While it is true that many people with this symptom have asthma, chronic obstructive pulmonary disease (COPD), or another lung condition, especially smokers, in other cases, such as in those with allergies, an irritated throat leads to coughing, and there are many potential causes of throat irritation. For instance, inflammation of the mucous membranes in the nose (rhinitis) and mucous accumulation in the back of the nose and throat (post-nasal drip) can both cause chronic irritation to your throat, leading to frequent coughing. In addition, ACE-inhibitors, a type of medication used to treat high blood pressure and heart conditions, can trigger a chronic cough as a side effect.
One common cause of chronic cough is actually gastroesophageal reflux disease (GERD), which occurs when stomach acid flows out of the stomach, through the lower esophageal sphincter, and up into the esophagus, causing an irritated throat. Our bodies produce stomach acid to help break down the food we eat, and the stomach has a special lining that prevents the acid from damaging it. However, the esophagus and throat do not have this protective layer. When you have acid reflux, the stomach acid irritates these sensitive tissues, which causes the common feeling of heartburn. When this reflux is ongoing, the persistent irritation can lead to chronic cough.
Symptoms and Complications
The obvious symptom is an ongoing dry cough that is non-productive. However, there are other symptoms that typically go along with this. These include an itchy throat, frequent throat clearing, hoarse voice, and a general irritation in your throat or chest.
While often seen as a relatively unimportant condition, it can have a large impact on your life. This includes physical symptoms, as chronic cough can interfere with your ability to sleep, cause incontinence, and interfere with your ability to breathe properly, which can sometimes lead to fainting. In some cases, it can even lead to rib fracture. On top of that, there are many emotional and social consequences of chronic cough. You might feel extremely frustrated that you are unable to stop coughing, or worry that you will have a coughing fit while in a busy place or at social gatherings, causing others to ostracize you. It can be a distraction at work, especially during meetings, as well as during school. During this time of COVID-19 precautions, there is heightened sensitivity to those exhibiting cough in the workplace.
Diagnosis
Since there are many potential causes, the diagnostic process will be different for each individual. Your physician will likely review your medical history and ask you questions about the frequency of your cough, whether it occurs more often at certain times of day, if there are any triggers for it, and any other questions that might help them narrow down the cause. They can then use this information to decide on what tests, if any, to run. This might include a chest x-ray, spirometry, CT scan, or bronchoscopy.
Your physician might refer you to a respirologist (also known as a pulmonologist), which is a doctor that specializes in lung disease. However, if your physician suspects that your cough is caused by GERD, they might refer you to a gastroenterologist. Allergies causing post-nasal drip can lead to chronic cough as well and should be assessed by an immunologist or allergist. Possibly the most difficult to diagnose is a neurogenic, or nerve-related, cause of cough.
Is it Something More Serious?
Chronic cough may be categorized by some as being usually benign, but if you experience warning symptoms such as breathlessness, coughing up blood, wheezing, shortness of breath, fever, chest pain, weight loss, or if you have a history of working with asbestos, smoking cigarettes, or inhaling chemicals, then it might be a symptom of something more dangerous. Chronic cough can be a significant health issue if it affects your ability to work or if it seriously affects your sleep. Whether or not you have these other symptoms, it is best to speak with your physician about any cough that lasts more than a couple of weeks. Having the correct diagnosis early means that you can treat the root cause more effectively. In some cases, a clear root cause might not be identifiable.
Treatment
Management can be tricky, as most over-the-counter cough remedies are ineffective, especially for long-term use. Cough treatments such as dextromethorphan are limited to symptomatic treatment of the common cold or flu. Some home remedies, such as consuming honey and lemon or gargling with salt water, might help reduce symptoms. However, the only way to properly treat the cough is to address the underlying cause.
If you have chronic cough caused by GERD, then treating the GERD adequately might be enough to relieve your symptoms. If stomach acid is no longer irritating the sensitive tissues of your esophagus and larynx, then your cough will likely go away in time. Treatment of GERD typically involves a combination of lifestyle and dietary adjustments along with medication. For example, you might need to remove certain foods from your diet, eat several small meals instead of two-three large meals, avoid eating right before bed, quit smoking, and/or reduce bodyweight, depending on your specific needs.
Over-the-counter heartburn medications such as Gaviscon®, Maalox®, Tums®, and Pepto-Bismol® can work temporarily, but aren’t adequate for long-term treatment. Instead, your physician will likely prescribe you a medication known as a proton pump inhibitor (PPI), which includes the following medications: omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet®), and pantoprazole magnesium (Tecta®). These medications block an enzyme necessary for acid secretion, which prevents you from experiencing heartburn in the first place, as opposed to treating the symptom after it occurs. Another class of medication, histamine-2 receptor antagonists (H2RAs) such as cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®), work by blocking the effect of histamine. Like with PPIs, this works by reducing the amount of acid you produce.
Conclusion
While chronic cough can sometimes be a symptom of a serious disease, it is often the result of a treatable condition, such as GERD. It is important to speak with your physician if you experience a cough that lasts more than a couple of weeks, in order to get a diagnosis so you can best treat the condition.