Reflux is one of the three most common causes of chronic cough, alongside asthma and postnasal drip — and it's frequently missed because the cough can exist with no heartburn at all. Two mechanisms are at play: acid reaching the throat and airway directly irritates the tissue there, and separately, acid in the lower esophagus can trigger a nerve reflex that causes coughing without any acid reaching the throat. This is why a reflux-related cough often doesn't respond to standard cough treatments — the trigger is downstream, not in the airway itself. Clues that point to reflux as the cause: a cough that's worse at night or after meals, a cough that started around the same time as other digestive symptoms, and a cough that hasn't improved after a few weeks of typical cold or allergy treatment.
