Chronic Cough & Laryngopharyngeal Reflux (LPR): Causes, Conditions & Treatment

Chronic cough is a common yet distressing condition that can persist for weeks or even months, often developing after an upper respiratory tract infection (URTI). While acute cough associated with URTIs is temporary, a cough that lasts more than eight weeks can be frustrating, embarrassing, and even painful. Nearly 40% of individuals experience chronic cough at some point in their lives.

Understanding Chronic Cough

A cough reflex is triggered when sensory nerves in the throat (pharynx), voice box (larynx), or lower respiratory tract send signals to the brain. This reflex can be easily stimulated by exposure to cold or dry air, irritants, or even prolonged talking.

Following a respiratory infection, nerve receptors throughout the airway become hypersensitive. This heightened sensitivity can exacerbate mild, pre-existing conditions such as post-nasal drip or gastroesophageal reflux disease (GERD), leading to persistent coughing.

Common Causes of Chronic Cough

1. Post-Nasal Drip

The nose plays a vital role in filtering, warming, and moisturizing the air we breathe by producing mucus. When mucus production increases, it can flow down the back of the throat, causing irritation and cough. Conditions such as allergic rhinitis and sinusitis often contribute to post-nasal drip.

2. Gastroesophageal Reflux Disease (GERD) & Laryngopharyngeal Reflux (LPR)

Nearly 40% of patients with chronic cough have GERD. This occurs when stomach acid flows back into the throat, irritating the larynx. In response, the body produces excess phlegm to neutralize the acid, leading to persistent throat clearing and discomfort.

LPR is a related condition where acid from the stomach travels up into the throat, causing inflammation. Unlike GERD, LPR is often silent, meaning it may not always present with heartburn. Instead, symptoms include:

• Sensation of a lump in the throat (globus sensation)

• Excessive throat phlegm and throat clearing

• Sour taste in the mouth

• Chronic cough

• Voice changes

Symptoms of LPR are typically worse after eating or upon waking up in the morning. In severe cases, it may cause chest pain, indigestion, or heartburn.

Diagnosis

A flexible nasendoscopy may be performed to examine the throat and larynx to rule out other conditions such as sinusitis or nasal allergies, which can mimic LPR symptoms. In some cases, a scope of the esophagus and stomach or special motility studies may be conducted.

Effective Treatment for Chronic Cough & LPR

Lifestyle Modifications

• Lose weight to reduce pressure on the stomach.

• Eat smaller, more frequent meals instead of large meals.

• Avoid lying down within 3 hours of eating to prevent acid reflux.

• Avoid tight belts or clothing that may increase abdominal pressure.

• Stop smoking, as it weakens the esophageal sphincter.

• Manage stress, as stress can worsen acid reflux.

Dietary Adjustments

• Reduce caffeine, alcohol, and citrus fruits to minimize irritation.

• Avoid spicy, fried, and oily foods, which can trigger reflux.

• Increase water intake to keep the throat moist.

Medical Treatment

Medications that reduce stomach acid production may be prescribed and should be taken 30 minutes before meals for 6-12 weeks to allow healing.

Specialist Care at Relentcare ENT Centre Kolazhy, Thrissur

At Relentcare ENT Centre Kolazhy, Thrissur, our expert ENT specialists, Dr. Salison Salim and Dr. Vidya Ramdas, provide comprehensive evaluation and treatment for chronic cough and LPR. Our team will assess your symptoms and create a personalized treatment plan to help you achieve long-term relief.

If you're experiencing persistent throat discomfort, cough, or voice changes, book an appointment with our specialists today.