Chronic Cough Due to Gastroesophageal Reflux Disease: Recommendation

Because the term acid reflux disease when applied to chronic cough due to GERD can be a misnomer and may mislead clinicians into thinking that all patients with cough due to GERD should improve with acid-suppression therapy, it is recommended that the term acid reflux disease no longer be used in the context of cough unless it can be definitively shown to apply. Unless acid reflux disease can be definitively proven, the more general term reflux disease should be used.
Because coughing can induce GER episodes, a cough-GER self-perpetuating cycle may be involved in the pathophysiology of a patient’s chronic cough. While cough-induced GER episodes are often observed in 24-h esophageal pH-monitoring tracings, the mechanisms by which these GER episodes are triggered by coughing is not known. www.mycanadianpharmacy.com

Based on inhaled tussigenic cough challenges, there is little evidence to support the theory that an increased sensitivity of the cough reflex is the sole explanation why some patients with GERD complain only or predominantly of cough, while others primarily have GI complaints. An increased sensitivity has been observed in patients with GERD who do not cough as well as in those who do cough.
In patients with chronic cough due to GERD, the term acid reflux disease, unless it can be definitively shown to apply, should be replaced by the more general term reflux disease so as not to mislead the clinicians into thinking that all patients with cough due to GERD should improve with acid-suppression therapy. Level of evidence, expert opinion; benefit, substantial; grade of recommendation. There is nothing about the character and timing of the cough due to GERD that distinguishes it from other causes of cough. It can present as a cough-phlegm (ie, productive cough) syndrome, just like chronic bronchitis from cigarette smoking, as well as a dry cough. It occurs nocturnally in only a minority of patients, and it can be “silent” from a GI standpoint up to 75% of the time. On the other hand, GERD should always be considered as a possible cause of chronic cough when patients also complain of typical and frequent GI symptoms such as daily heartburn and regurgitation, especially when the chest-imaging studies and/or clinical syndrome are consistent with an aspiration syndrome.

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