Recently I have seen three patients with emphysematous changes in the lungs that are nonsmokers. All three have presented with a chronic cough and recurrent sinusitis, but have no history of cigarette smoking. They also have one other thing in common – they all three have Gastroesophageal Reflux Disease or GERD that is not well-controlled.
Initially, all three patients dismissed the existence of having GERD until they all underwent a barium swallow that showed active reflux. The reason for their dismissal was they weren’t experiencing heartburn. Unfortunately for many patients the extra-esophageal manifestations of reflux were not present. Common manifestations include chronic cough, asthma and sinusitis which are not commonly recognised as being associated with GERD. These patients find themselves being treated symptomatically without addressing the underlying cause, eventually leading to permanent damage, such as emphysematous changes to the lungs.
One of the patients in particular has complete disruption with part of their stomach above the diaphragm and will need surgical repair. Another is undergoing an evaluation to see if surgery is an option and the third is attempting lifestyle changes before seeking surgical or medical intervention.
How Uncontrolled GERD Causes Permanent Lung Damage and Idiopathic Pulmonary Fibrosis
To many, GERD is considered a benign disease. It is not. It potentially can cause permanent irreversible damage. Recent medical literature has shown that GERD plays a role in the development of Idiopathic Pulmonary Fibrosis (IDF). It is well known that Pulmonary Fibrosis
has been associated with cigarette smoking, but in patients with Idiopathic Pulmonary Fibrosis, they are all non-smokers. With IDF, it is the gastric acid and digestive enzymes that find their way into the lungs that destroys the lung tissue.
Why Smoking and Vaping Both Worsen GERD-Related Lung Damage
In cigarette smokers with chronic lung issues, it should be pointed out that their lung damage is two-fold. Not only does cigarette smoke damage the lung tissue, but nicotine causes relaxation of the lower esophageal sphincter (LES) allowing reflux to occur. Spoiler alert, vaping is not safer and I have had patients who switched to vaping only to find that their chronic cough worsened. Why? Simple. Many vaping products contain more nicotine and with more nicotine there is more relaxation of the LES causing more symptoms like coughing.
For patients with a chronic cough, or newly diagnosed asthma as an adult, discuss with your primary care practitioner the possibility of having GERD as the underlying cause for your cough. It may avoid you developing permanent lung damage.
