Increased Coughing: Causes and Concerns in Adults - Otolaryngology

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Increased coughing, especially when accompanied by sensations of choking or difficulty swallowing, can be concerning and may indicate underlying health issues. Let's break down the potential causes and concerns related to your symptoms, particularly in the context of gastroesophageal reflux disease (GERD) and post-nasal drip.

1. Gastroesophageal Reflux Disease (GERD): GERD is a condition where stomach acid frequently flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and sometimes cough. The acid can irritate the throat and larynx, triggering a cough reflex. This irritation can be particularly pronounced when lying down or after eating, as the position can exacerbate reflux. In your case, if you notice an increase in coughing after consuming liquids, it could be that the reflux is more pronounced with these types of foods, especially if they are consumed quickly or in large amounts. The sensation of choking may also occur if the reflux is severe enough to cause aspiration, where small amounts of stomach contents enter the airway.

2. Post-Nasal Drip: This condition occurs when excess mucus accumulates in the back of the throat, often due to allergies, sinus infections, or colds. The mucus can drip down the throat, leading to irritation and a cough reflex. If you have a history of nasal congestion or allergies, this could be a contributing factor to your increased coughing. The mucus can also be more pronounced when lying down, as gravity can cause it to pool in the throat, leading to more frequent coughing episodes.

3. Age-Related Changes: At 38 years old, it is possible to experience some natural aging effects on the muscles involved in swallowing. As we age, the muscles can lose strength and coordination, which may lead to difficulties in swallowing (dysphagia) and an increased risk of aspiration. This could explain why you find yourself choking more frequently, particularly with liquids, which can be more challenging to control than solid foods. However, significant changes in swallowing function typically occur later in life, so while it is a possibility, it may not be the primary cause of your symptoms.


Recommendations for Management:
- Dietary Adjustments: Consider modifying your diet to minimize reflux symptoms. This includes avoiding large meals, spicy foods, caffeine, and alcohol, which can exacerbate GERD. Eating smaller, more frequent meals may also help.

- Posture and Positioning: After eating, try to remain upright for at least 30 minutes to reduce the likelihood of reflux. Elevating the head of your bed can also help minimize nighttime symptoms.

- Hydration: Ensure you are adequately hydrated, as this can help thin mucus and reduce post-nasal drip. However, be mindful of how quickly you consume liquids.

- Consultation with a Specialist: Given your symptoms, it may be beneficial to consult with a gastroenterologist for a thorough evaluation of your GERD and its management. Additionally, an ENT specialist can assess any potential issues related to post-nasal drip or throat irritation.

- Swallowing Assessment: If you continue to experience choking episodes, a swallowing study may be warranted to evaluate your swallowing function and rule out any significant issues.

In summary, increased coughing can stem from various causes, including GERD, post-nasal drip, and age-related changes in swallowing function. Addressing these factors through lifestyle modifications and medical consultation can help alleviate your symptoms and improve your quality of life. If symptoms persist or worsen, seeking medical advice is crucial to rule out more serious conditions.