Reflux cough: how acid reflux causes a chronic cough and what helps

Acid reflux happens when stomach acid travels up towards the throat. The NHS describes heartburn as a burning feeling in the chest caused by this, and says that if it keeps happening it may be called gastro-oesophageal reflux disease (GORD). The same movement of acid, or the reflex it sets off, can irritate the throat and airways and lead to a cough.

Most coughs have a different explanation. The NHS says most are caused by a cold or flu, and that a cough will usually clear up on its own within 3 to 4 weeks. When a cough lingers beyond that, reflux is one of the recognised possibilities to consider, together with smoking, allergies such as hay fever, infections like bronchitis and mucus dripping down the throat from the back of the nose.

Reflux does not always announce itself with heartburn, but the NHS lists several features that may point towards it.

• A burning sensation in the middle of the chest and an unpleasant sour taste in the mouth.

• A cough or hiccups that keep coming back.

• A hoarse voice, bad breath, bloating and feeling sick.

• Symptoms that are worse after eating, when lying down or when bending over.

• Symptoms linked with trigger foods and drinks such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods.

The NHS says lots of people get heartburn from time to time, often for no obvious reason. It can be caused or made worse by certain foods and drinks, being overweight, smoking, pregnancy, stress and anxiety, hormonal changes, and some medicines such as anti-inflammatory painkillers like ibuprofen. A hiatus hernia, where part of the stomach moves up into the chest, can contribute; the NHS says it is very common over 50 and that symptoms include heartburn, acid reflux, bloating, nausea and pain or difficulty on swallowing. A stomach ulcer or a bacterial infection in the stomach can also be involved.

There is no single test for a reflux cough. A GP will usually ask about the cough, any heartburn or sour taste, timing relative to meals and lying down, smoking, medicines and allergies, and will listen to your chest. The NHS says a GP investigating a cough might listen to the chest with a stethoscope, take a mucus sample, or order an X-ray, an allergy test or a lung function test, with a hospital referral being rare.

If medicines do not help or symptoms are severe, the NHS says a GP may refer you to a specialist for tests to find out what is causing the symptoms, such as a gastroscopy, tests for bacteria that can cause heartburn, or surgery on the stomach or food pipe to stop acid reflux. A trial of treatment for reflux, with review of the cough, is a common practical way to see whether reflux is contributing.

The NHS suggests simple lifestyle changes: eat smaller, more frequent meals, try to lose weight if overweight, find ways to relax, avoid trigger foods and drinks, do not eat within 3 or 4 hours before bed, avoid clothes that are tight round the waist, do not smoke and do not drink too much alcohol. Raising the head of the bed by around 10 to 20cm using wood, bricks or books may help, but extra pillows are not recommended because they can increase pressure on the belly and make symptoms worse.

A pharmacist can recommend antacids or alginates, ideally taken with food or soon after eating. The NHS says they help in the short term but will not cure the problem and should not be taken regularly for long periods. If lifestyle changes and pharmacy medicines do not help, a GP may prescribe a proton pump inhibitor such as omeprazole or lansoprazole, usually for 4 or 8 weeks, and a different type such as famotidine if that does not help. Go back to the GP if symptoms return after stopping.

Do not stop any prescribed medicine without talking to a doctor first, as the NHS advises.

See a GP for a cough lasting more than 3 weeks, losing weight for no reason, or a weakened immune system. For reflux itself, see a GP if lifestyle changes and pharmacy medicines are not helping, if you have heartburn most days, or if you also have food getting stuck in your throat, frequent vomiting or weight loss for no reason.

Ask for an urgent GP appointment or get NHS 111 help if a cough is very bad or quickly gets worse, you feel very unwell, you have chest pain, you find it hard to breathe, or you are coughing up blood. Do not assume a cough is reflux without that being checked.

Many people find the cough improves once reflux is controlled, though this can take weeks, and symptoms may return if the triggers come back. Some need longer-term acid-lowering treatment under review.

On the NHS, a GP appointment, a trial of treatment and referral for gastroscopy or specialist review are the usual route. Private gastroenterology or ENT appointments can offer quicker access to endoscopy, but the same causes and treatments are considered.