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When we cough, air is being forcefully expelled out of our lungs and airways. The cough reflex was likely designed to allow us to rid our breathing tubes of irritating substances and foreign bodies. When our airways become inflamed, as they do as a result of infection, our cough reflexes help us get up the excess mucus or phlegm produced.

However, when a cough becomes chronic – lasting for weeks, months or years without apparent cause – or when the cough is recurrent, it’s easy to understand why it’s no longer considered beneficial to the host. Chronic coughs are no fun. They keep people up at night, interfere with activity during the day and can be associated with a host of other problems.

The usual causes of chronic cough are asthma (with or without wheeze), post-nasal drip and chronic bronchitis. All of these can be associated with allergy, but in most adults, they aren’t, at least not in my experience. Most chronic bronchitis is caused by cigarette smoking. Less common causes of chronic cough include tumors and heart problems. Some chronic coughs are psychological or nervous habits.

However, there are people who have chronic coughs with no apparent cause. According to a recent review published in the Canadian Medical Association Journal, between 4 and 10 per cent of these individuals are suffering from gastroesophageal reflux (GER). That’s fancy for stomach contents going in the wrong direction, up the esophagus or gullet.

A group of doctors from McMaster University Medical School reviewed their clinic’s charts to find patients who had chronic coughs with no cause and who hadn’t responded to treatment. They came up with 20 people who’d been coughing from three months to 25 years. Fifteen of the 20 had symptoms of GER and 12 coughed mainly at night.

All 20 had normal physical examinations. None had abnormalities on chest x-rays that could account for their coughs. Eighteen of the 20 were non-smokers. None had evidence of allergy or asthma.

They attempted to demonstrate GER in 14 of the 15 patients who had symptoms. That’s done by asking the patient to drink a radio- opaque liquid and then having him or her x-rayed. In 6 of the 14, the x-rays demonstrated GER.

Even though a firm diagnosis of GER wasn’t made on 14 of the patients, all of them were treated as if they had it. The treatment consisted of avoiding fatty foods, coffee, tea, cigarettes and alcohol. All these can relax the muscles at the junction between the stomach and esophagus.

They were told to eat small regular meals to avoid overloading the stomach. Eating within three hours before bed was to be avoided, because GER tends to occur more frequently at night when you’re lying down. When we’re sitting or standing, gravity helps to keep the stomach contents in the stomach. Also, in an effort to prevent bedtime GER, patients were advised to elevate the head of their beds by 15 to 20 centimetres (6 to 8 inches). You do that by putting blocks under the bed posts, not by sleeping on extra pillows.

In addition, the patients were put on drugs to reduce the output of stomach acid and increase the emptying time of the stomach, and at bedtime they were to take some antacid.

Seventy per cent of the patients responded to therapy and stopped coughing.

Five of the patients who continued to cough in spite of GER therapy had their stomachs and esophagi examined directly using an endoscope. All of them had evidence of GER. Four of the five had surgery to correct the GER and at their three month follow-up visits were cough-free. The fifth person, who declined surgery, was still coughing.

Symptoms of GER are heartburn and indigestion; a sour taste in your mouth when you bend down, lie down or wake in the morning; morning laryngitis; nausea; abdominal bloating; trouble swallowing; choking at night; and cough, especially when it occurs at night. If you’ve got any of these symptoms and a chronic cough, maybe a course of GER therapy is worth discussing with your doctor. And, even if you don’t have symptoms of GER, but you do have a chronic cough, a trial of therapy might be worth while.

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