Chronic Cough Due to Gastroesophageal Reflux Disease: Possible Cause
On the basis of the above considerations, the panel recommends that an empiric trial of medical antireflux therapy be performed in patients who meet the clinical profile (Table 1) predicting that silent GERD is the likely cause of chronic cough or in patients with chronic cough who also have prominent upper GI symptoms (eg, heartburn, sour taste, and regurgitation) that are consistent with GERD. The panel does not think that it is necessary to order tests to assess for the potential of GERD before observing the response to empiric therapy. Link
While it is not known what constitutes the minimum effective medical therapy for treating the majority of patients with chronic cough due to GERD, the panel, by expert opinion, recommends (1) dietary and lifestyle modifications, (2) acid suppression therapy, (3) the addition of prokinetic therapy (ie, to enhance gut motility) either initially or if there is no response to the therapy stated in steps 1 and 257 (see section on Treatment), and (4) that the response to therapy be assessed within 1 to 3 months. In some patients, there can be a delay of 2 to 3 months in improvement with therapy that will eventually eliminate the cough. If empiric treatment fails, it cannot be assumed that GERD has been ruled out as a cause of chronic cough; rather, the objective investigation for GERD is then recommended because the empiric therapy may not have been intensive enough or medical therapy may have failed.
In patients with chronic cough who also complain of typical and frequent GI complaints such as daily heartburn and regurgitation, especially when the findings of chest-imaging studies and/or clinical syndrome are consistent with an aspiration syndrome, the diagnostic evaluation should always include GERD as a possible cause. Level of evidence, low; benefit, substantial; grade of recommendation, B
Patients with chronic cough who have GI symptoms that are consistent with GERD or who fit the clinical profile described in Table 1, should be considered to have a high likelihood of having GERD and should be prescribed antireflux treatment even when they have no GI symptoms. Level of evidence, low; benefit, substantial; grade of recommendation, B
In patients with chronic cough, it should not be assumed that GERD has been definitively ruled out as a cause of cough simply because there is a history of antireflux surgery. Level of evidence, low; benefit, substantial; grade of recommendation, B
In patients with chronic cough, while tests that link GERD with cough suggest a potential cause-effect relationship, a definitive diagnosis of cough due to GERD requires that cough nearly or completely disappear with antireflux treatment. Level of evidence, low; benefit, substantial; grade of recommendation, B