LPR (Silent Reflux) Cough: Causes & Treatment

Cough can have many causes. While an acute cough is frequently caused by a cold, silent reflux can be the cause of chronic, long-lasting cough. Silent reflux as a possible cause for chronic cough is often overlooked.

How LPR Causes Cough

The primary cause of LPR symptoms is the stomach enzyme pepsin irritating the mucous membranes of the throat and airways.[1] The body responds to the resulting inflammation by producing mucous. Coughing is simply the body’s reaction to clear the airways of that mucus.

LPR Aggravates Other Causes of Cough

LPR can not only cause coughing, but it can also aggravate coughing that originally stems from other diseases. Respiratory conditions, such as asthma and allergies, are two examples where silent reflux can make the symptoms worse.

This article explains in more detail how LPR aggravates respiratory diseases.

Because LPR irritates the airways, people with LPR are also more susceptible to airway infections.

How to Recognize That LPR is the Cause of Cough

A cough that is caused by silent reflux closely resembles coughs with other causes. For this reason, the cause of a cough is often not diagnosed correctly. For instance, asthma or allergies may be thought to be the cause while, in fact, it is reflux that is producing the symptoms.

Nevertheless, some indicators help to determine whether or not LPR is the root of a cough:

LPR Cough Triggers Other Symptoms.

One crucial indicator is that LPR leads not only to cough but also to a range of other symptoms, such as sore throat and hoarseness. A detailed analysis of co-occurring symptoms helps to determine the likelihood that the cough is caused by LPR. For this purpose, the RSI test is a useful tool for assessing the severity of LPR symptoms and finding out whether the signs point towards LPR.

Approximately 25% of chronic cough cases are associated with acid reflux.[2] For some people, the cough is stronger after meals. But not everybody experiences this.

Treatment of LPR Cough

To get rid of the cough, the cause has to be eliminated.

Only a treatment that removes the cause can be successful long-term. In the case of LPR cough, the reflux needs to be controlled as far as possible. At the same time, symptoms can be reduced through the avoidance of acidic foods and drinks.

Reflux that irritates the esophagus and causes typical symptoms such as heartburn is normally treated with proton pump inhibitors (PPIs). PPIs are, however, not effective against silent reflux.[3] This is because PPIs merely suppress acid production, but pepsin still reaches the throat, where it gets activated by acidic foods and causes damage.

In most cases, dietary changes can drastically improve LPR symptoms such as cough. An adaptation of nutritional habits not only reduces reflux but also minimizes the activation of pepsin.

In my online course about the treatment of LPR, you will learn in detail which dietary changes you can eliminate LPR cough with.


References

[1] Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope. 2007;117(6):1036–9.

[2] Madanick RD. Management of GERD-related chronic cough. Gastroenterol Hepatol (NY). 2013;9(5):311–3.

[3] Reimer C, Bytzer P. Management of laryngopharyngeal reflux with proton pump inhibitors. Ther Clin Risk Manag. 2008;4(1):225–33.

Gerrit Sonnabend
 

Gerrit is a German data scientist & medical publisher. His formal education is in qualitative research. He had severe reflux himself. Read more about him here.