aswander

I know what you have, and it is indeed acid reflux. 5 years is a long time to deal with a chronic, severe and unrelenting cough.

Though acid reflux is best known for its famous symptom "heartburn", there is a secondary manifestation of acid reflux called larygopharyngeal reflux (LPR). See you larynx is not actually an organ, it's a region of your esophogous consisting of different parts. This area called the larynx usually is pressurized, but with LPR, you lose pressure there and the acid is able to irritate the various parts of the larynx, which has no natural protection agains acid. This area is called the upper esophageal spinchter.

People with heartburn have a problem with the lower esophageal spinchter. It's possible to have problems with both, but most people have more of a problem with one over the other.

The treatment is simple - it's 2 doses per day of a PPI. This is critical! 1 dose a day will not cut it. You must take 2 doses per day. Secondly, people with LPR do not respond to Prilosec OTC. It is not the same as Prilosec by prescription, and is even made by a different company. Instead you have 5 choices of prescription-version PPIs to choose from:
-Nexium (most effective for LPR)
-Prevacid
-Prilosec (brand name by prescription)
-Prilosec (generic by prescription)
-Protonix (not great for LPR)
-Zegrid (new medication, but just a combination of Prilosec and Tums)
-Aciphex (seems to work pretty well for LPR patients)

Now that you know that you must take 2 PPIs - the next thing is determining how you'll take them. Many LPR patients need to take the 2 doses together, first thing in the morning - they need a powerful amount of medication at the same time. Then there are other LPR patients who claim that taking one in the morning and one at night is better. I'm someone who takes the 2 doses together in the morning. When I've separated them, the symptoms come back.

LPR is a lifetime condition. You will be on the meds indefinately. However, you should be able to toss your inhaler and asthma meds pretty soon. Both my brother and best friend had asthma for life. Once they started on PPI therapy, the asthma went away.

You may need to be on 2 dose a day therapy for abotu 30 days before you see significant improvement. On the other hand, after having a severe and unrelenting cough for 6 months, the 2 dose a day therapy put the kabosh on my symptoms 20 minutes after taking my first double dose. It can be that fast - but I don't want to get your hopes up too much.

There is a gradual growing understanding of the layngeal impact of acid reflux in the otolaryngology and PCP community. However, it is not a mature understanding. The doctors who are more familiar with this condition tend to ENTS (otolaryngologists) in large cities affiliated with university hospitals. They often tend to see lots of singers/voice patients (like Ashley Simpson, etc.). LPR is very common among sngers due to overuse of the voice. I can recommend several doctors in Philadelphia, NYC, and New Haven, CT.

Standard protocal for treating LPR is 2 doses of a PPI per day. Don't let anyone tell you anthing different. And get rid of the Prilosec OTC. It didn't work for me, and even my doctor strongly recommends against it, as many of her LPR patients switched to it when it came out, and then had to go back on prescription PPI therapy because all their symtpoms returned.

Finally, the forum on healthboards that deals with this is the "acid reflux" forum. About 50% of the posts have to do with LPR.

LPR is not asthma. But LPR can cause asthma-like symptoms. However, asthma meds do not effectively treat the symptoms.

Good luck!