respiratory reflux
August 17, 2020

Silent Reflux – Breathing, Sinus or Throat Problems? Explore Acid Reflux!

respiratory reflux


  • Heartburn and indigestion are familiar symptoms of GERD (gastroesophageal reflux disease.) However, they are experienced by fewer than 20% of people with acid reflux.
  • More common than GERD is silent reflux / LPR (laryngopharyngeal reflux), which is acid reflux into the throat, often occurring at night during sleep. LPR is also known as “respiratory reflux.”
  • The following are the most common symptoms of acid reflux (GERD & LPR) in decreasing order of frequency: postnasal drip, excess throat mucus, chronic throat clearing, a lump-in-the-throat sensation, hoarseness, sore throat, heartburn, chronic cough, difficulty swallowing, and choking episodes.
  • LPR is the great masquerader of our time, affecting as many as 100 million Americans. It can cause almost all respiratory symptoms and diseases, including asthma, allergies, sinus disease, laryngitis, LPR shortness of breath, choking episodes, chronic cough, bronchitis, pneumonia, and sleep apnea. And some people experience no reflux symptoms at all in the initial stages.

It takes just a minute to take the Reflux Symptom Index quiz below to find out if you may have silent reflux.

I developed an index to determine if someone has acid reflux in 1987, and you can see the peer-reviewed research into its validity in Journal of Voice in 2002. Spoiler alert: it was found valid, and I’m so proud that this pioneering work is still standing the test of time as a reliable clinical tool.

Today, it is used by physicians around the world to assess the presence and degree of reflux. Many people have silent reflux and don’t know it. Take the quiz below to see if you do.

Add up your scores for each line – if your score is 15 or more, you have a 90% chance of having reflux, especially airway reflux.

Acid Reflux Is Not Just About Heartburn and Indigestion

Most importantly, understand that you do not need to have heartburn or indigestion to have reflux.

In fact, while the primary symptom of GERD is heartburn, other symptoms are more common in LPR: shortness of breath, postnasal drip, chronic throat clearing, chronic cough, sore throat, hoarseness, lump-in-the-throat sensation, and difficulty swallowing.

The misconception among patients and physicians that acid reflux is heartburn has had colossal negative health consequences, missing the reflux diagnosis for many.

Silent Reflux Breathing Problems and Symptoms

We examined the intake data from a large number of my patients with reflux and were surprised to find that only 17% ever had heartburn, and it was the chief complaint of only 7%. The data also suggested that most LPR patients had an average of six of these symptoms.

Below is a list of acid reflux symptoms, including both GERD and LPR breathing problems. This long list highlights that reflux has a much wider range of symptoms than most patients and doctors believe. It is crucial to know that reflux is possible (and common) even in the absence of heartburn.

Chest pain
Choking episodes
Chronic cough
Chronic throat clearing
Croup (esp. recurrent croup)
Dental and gum disease
Difficulty breathing
Difficulty swallowing
Ear fullness and popping
Excessive throat mucus
Food coming back up
Food getting stuck in throat or esophagus
Inability to take air in
Lump-in-the-throat sensation
Nasal congestion
Noisy breathing
Postnasal drip
Shortness of breath
Sleep apnea
Stomach fullness
Vocal fatigue
Voice breaks

What to Do if You Have Acid Reflux


 – Don’t take PPIs!

 – Understand that acid reflux increases your risk of esophageal cancer, so get screened

Reflux is curable with effort and commitment to change.

I’ve written four books about these topics: Dropping Acid: The Reflux Diet Cookbook & CureThe Chronic Cough EnigmaDr. Koufman’s Acid Reflux Diet, and Acid Reflux in Children.

However, here are the most important pieces of advice I can offer:

  1. No eating or drinking within five hours of going to bed
  2. Sleep on an incline no less than 45-degrees (gravity helps)
  3. Eat five small meals
  4. No fried or high-fat foods
  5. No alcohol, chocolate or soft drinks (including fruit juice) of any kind
  6. Take Pepcid 20 mg. before each meal and before bed
  7. Take a tablespoon of Gaviscon Advance Aniseed after each meal and before bed (not available in stores in the U.S., but available online)
  8. Drink alkaline water as much as you conveniently can, an alkaline pitcher is convenient (and test it with pH paper or a pH tester to make sure it’s 8.0 or greater)

If you’ve read at least one of my books and you’re following this guidance and you still need help, you can book a consultation with me.

P.S. – Why Doesn’t My Doctor Know About This?

I get asked this all the time: “Why doesn’t my doctor know about this?!”

My primary research on acid reflux and chronic cough has been available for decades. Dropping Acid has been a best-seller for a decade. And I was on TV and quoted in mainstream media for many years. But the medical community remains virtually unaware that LPR (laryngopharyngeal reflux), today often called silent reflux or respiratory reflux (all terms I coined), is a major cause of respiratory issues and chronic cough. In addition, neurogenic cough seems almost never properly diagnosed.

Thousands of my patients have been on a merry-go-round of specialists… a GI doctor, an ENT, an allergist, an asthma specialist. They’ve had tens of thousands of dollars of tests, prescriptions for medications that never could have helped them, and their respiratory issues never improved.

The problem in the U.S. is over-specialization. Most Americans mistakenly believe that they must see specialists for almost every medical problem. What people don’t know is that specialists determine what services insurance will pay the most for, and they can choose to deliver those expensive services… even for patients who don’t need them! The idea of dividing the body up into small, non-overlapping, anatomic areas makes no sense. The respiratory and digestive systems are intimately connected, and specialists do not seem to know that.

Imagine building a house by allowing each workman to do his own thing. The plumber would put a sink in every room. The electrician would install chandeliers on every ceiling. The carpenter would panel every room in luxurious wood. That’s how America’s medical specialist system works.

The evolution of my personal medical practice as an expert in acid reflux that affects the throat and airway (LPR, silent reflux, respiratory reflux – all terms that I coined) helped me see that silent respiratory reflux was ubiquitous. That means it’s all over the place, and it’s likely in almost half of Americans. REFLUX is the single most common cause of “allergies,” “asthma,” “sinus disease,” true sleep apnea, and chronic cough.

Please read up and advocate for yourself, finding solutions that may be elusive through traditional care channels.

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