Drinking alcohol can often cause a cough, a common, though usually temporary, reaction. This symptom is typically not a direct effect of alcohol on the lungs, but rather a consequence of its action on the digestive and respiratory systems. The cough results from two primary mechanisms: irritation caused by stomach acid backing up into the throat, and inflammatory or allergic-like responses triggered by non-ethanol components in the beverage.
The Primary Role of Acid Reflux and Esophageal Irritation
The most frequent cause of alcohol-induced coughing involves its effect on the lower esophageal sphincter (LES), the muscle separating the esophagus from the stomach. Alcohol acts as a muscle relaxant, causing the LES to loosen its seal. This allows stomach acid to migrate upward in a process known as Gastroesophageal Reflux (GERD). This acid backwash irritates the lining of the esophagus and throat, triggering a reflex cough as the body attempts to clear the material.
This mechanism can lead to “silent reflux,” or Laryngopharyngeal Reflux (LPR), where acid reaches the upper airway without causing typical heartburn. The resulting irritation of the vocal cords and pharynx triggers the need to cough. Beverages with high ethanol concentrations, such as strong spirits, are often the worst offenders because they have a potent relaxing effect on the LES.
Non-Ethanol Components That Trigger Respiratory Symptoms
Beyond the direct effects of ethanol and acid reflux, certain non-alcohol ingredients in beverages can trigger inflammatory and allergic-like responses that manifest as a cough. These components include naturally occurring compounds and added preservatives that affect the respiratory tract. For instance, biogenic amines like histamine are present in many fermented drinks, particularly aged products such as red wine, dark beers, and sparkling wines.
In sensitive individuals, a deficiency in the enzyme diamine oxidase (DAO), which breaks down histamine, allows the compound to build up in the body. This histamine overload can induce symptoms that mimic an allergic reaction, including rhinitis, wheezing, and coughing, due to inflammation or airway constriction. Sulfites, commonly used as preservatives in wine and beer, are another potential trigger for respiratory issues.
For people with pre-existing conditions like asthma, sulfites can be problematic, potentially causing bronchoconstriction and exacerbating their underlying respiratory disease. Up to 40% of people with asthma report experiencing respiratory symptoms, including coughing, after consuming alcohol. In these cases, the cough results from an inflammatory reaction within the airways, not acid.
Strategies to Minimize Alcohol-Induced Coughing
Adopting specific lifestyle changes can significantly reduce the likelihood of experiencing an alcohol-induced cough. To mitigate the risk of acid reflux, avoid drinking on an empty stomach, as food helps buffer stomach acid. Consuming alcohol slowly also lessens the immediate impact on the lower esophageal sphincter, reducing the chance of stomach contents flowing back up.
It is advisable to remain upright for at least three hours after drinking and avoid lying down immediately before bed. This helps keep stomach acid contained by gravity. For individuals who suspect their cough stems from histamine or sulfite sensitivity, opting for clearer spirits like vodka or gin mixed with water or low-acid juice may be beneficial. These beverages generally contain fewer biogenic amines and preservatives than fermented drinks like red wine or beer.
Maintain proper hydration by alternating each alcoholic drink with a glass of water. Alcohol is a diuretic, and dehydration can dry out the throat and respiratory passages. This dryness makes the passages more susceptible to irritation and triggers the cough reflex. Overall, moderation and paying close attention to which specific types of beverages trigger the symptoms can lead to effective management.