Watch your food habits, not all coughs come from the lungs

Do you have a cough that is not responding to routine measures? Do you getunexplained hoarseness of voice? Do you have trouble with your throat early in the morning which clears up during the day?      Then this may be for you. GERD— gastro esophageal reflux disorder—is a condition wherein food remnants and gastric acid contents creep up the food pipe into the oropharynx (common receptacle for the food pipe and wind pipe) and spill into the windpipe passively.      In these patients, the gastro-esophageal sphinctervalve between the food pipe and the stomach, is defective and allows regurgitation (backward flow) of stomach contents.      At night during sleep, when the horizontal posture aids the backward flow, the stomach remnants find their way up and soil the respiratory tree. The chemical nature of the contents cause inflammation of the vocal chords and as they trickle down the trachea, they irritate the respiratory lining. When this occurs with periodic regularity almost every night, the tracheal inflammation becomes chronic which the normal body response is unable to ward off. Chronic dry cough and a stubborn hoarseness of voice is the result. The cough is often likened to the short sharp barking of a dog.      Standard therapy directed towards the respiratory track proves ineffective and symptoms continue unabated. The patient goes from family physician to chestconsultant to ENT specialist, with no avail. Clinical examination is near normal and blood tests and X-rays of the chest draw a blank.      Some even get CT scans of their lungs. By then they have consumed antibiotics, cough syrups, antihistamines and sometimes even inhalers and nebulizers. Grandma and home remedies have failed.      GERD is more common in obese patients, those individuals who lie down soon after meals and those who eat heavy, large meals late at night. The content of the spicy, often alcohol-containing meal, the late timing and the lax tone of the abdominal muscles, tend to open up the sphincter and permit leakage up the food pipe. In addition to these bizarre respiratory symptoms, such patients tend to have water brash and heartburn owing to the gastric hyperacidity.      While treatment lies in changing the lifestyle and eating habits, drugs are available to increase the tone of the sphincter, neutralize the hyperacidity and blunt the hypersecretion.      In fact, the treatment of GERD focuses on the GI tract and the respiratory symptoms are seen to vanish— all coughs do not emanate from the lungs! While a lax sphincter may be due to a primary disorder, more often than not it is bad lifestyle that is the culprit.      With Diwali round the corner and parties dime a dozen, those vulnerable should take heed about late night dinners for "lungs se ooper" stomach is the "Boss" when it comes to a teasing cough.      (Dr Hemant Thacker is a consultant physician and cardio metabolic specialist in south Mumbai Hospitals. Email: dochpt@gmail.com)