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The Answer Doc by Dr. Christopher Munger
Possible cause of chronic cough
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    Q: Doc, I am 34 years old, and I think I’m in good health. I watch what I eat, exercise regularly and don’t take any regular medication. Over the past year, I have developed a chronic cough that won’t go away. I have also been waking up in the morning with this really awful tasting phlegm in my mouth. I have lived here all my life and I’ve never had allergies or asthma. What could this be?
    A:  One possibility is that you may have gastroesophageal reflux disease, more commonly known as GERD.
    Sixty-five percent of adult Americans have suffered heartburn at one time or another. Most can relate to the sensation of acid rolling up their throat after a heavy or fatty meal or after particularly spicy foods. For some, these symptoms can be present several times a week or may persist on a daily basis. However, there are some patients with GERD who do not have the typical symptom of heartburn.  These atypical symptoms can include chronic cough, frequent hoarseness or loss of voice, chest pain, and loss of dental enamel.
    Based on your lack of other symptoms, you may have an atypical case of GERD. GERD occurs when the contents of the stomach “reflux” into the esophagus. Sometimes this reflux can travel all the way up the esophagus into the pack of the mouth and even spill into the larynx (voice box) and down into the lungs. The acid in these contents is what usually causes the “burn” of heartburn, but it can also lead to real damage if it occurs over time. The acid can lead to precancerous changes in the esophagus called Barrett’s Esophagus, can lead to thickened vocal cords and even cause the airways to become spastic which can lead to a chronic cough.
    What can you do to treat the symptoms of GERD and how can you prevent the symptoms from reoccurring?  Most importantly, if you have had the symptoms of a chronic cough for over a year, I would definitely suggest seeing your doctor and bringing up the possibility of GERD.  Outside of seeing your doctor, here are some things you can do to treat and help prevent the symptoms of GERD.
     1. Avoid foods and drinks that make reflux more likely to occur. These include chocolate, peppermint, onions, coffee, alcohol, high fat foods, citrus and tobacco.
     2. Elevate the head of your bed 30 degrees.
     3. Avoid laying down directly after meals.
     4. Medications: for GERD there are two types of medication that are available over the counter (OTC).  One type is called an H2 blocker. This stops the release of acid by the stomach. They work quickly but usually need to be taken twice a day.  OTC H2 blockers include Pepcid and Zantac.  The other type is called a Proton pump inhibitor or PPI.  PPIs work by blocking the production of acid. They sometimes can take a day or two to reach full effect but usually only need to be taken once a day. These medicines have also been shown to help repair some of the damage that GERD can cause to the esophagus. An example of an OTC PPI is Prilosec OTC.
    If you have frequent heartburn or any of the other atypical symptoms of GERD, you really should seek medical advice and hopefully prevent long term damage to your body.

    Dr. Christopher Munger’s column appears every other Sunday. Dr. Munger is board certified in family practice. He is a member of the Family Health Care Center in Statesboro and admits patients to East Georgia Regional Medical Center. He is originally from California. He received his bachelors degree from UCLA, his medical degree from Columbia University in New York City and completed his training in family practice at the University of Virginia. He lives in Statesboro with his wife and two dogs.
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