Abstract
PurposeGastro-oesophageal reflux disease (GORD) is commonly thought to play an important role in chronic cough and patients are often empirically treated with acid suppression therapy. We sought to investigate the response rate to acid suppression treatment in patients with and without heartburn attending two specialist cough clinics.MethodsA retrospective review of 558 consecutive patients referred to two specialist cough clinics was performed (UK and USA). Patients who were treated with acid suppression were included and their documented response to treatment was collected. Binary logistic regression was used to ascertain the value of reported heartburn in predicting the response of chronic cough to acid suppression therapy.ResultsOf 558 consecutive referrals, 238 patients were excluded due to missing data or cough duration of < 8 weeks. The remaining 320 patients were predominantly female (76%), with mean age 61 yrs (± 13) and 96.8% non-smokers, with chronic cough for 36 (18–117) months. Of 72 patients with heartburn, 20 (28%) noted improvement in their cough with acid suppression, whereas of 248 without heartburn, only 35 (14%) responded. Patients reporting heartburn were 2.7 (95% C.I. 1.3–5.6) times more likely to respond to acid suppression therapy (p = 0.007).ConclusionIn specialist cough clinics, few patients report a response of their chronic cough to acid suppression therapy. Nonetheless, heartburn is a useful predictor substantially increasing the likelihood of benefit.
Highlights
Gastro-oesophageal reflux disease (GORD) is thought to play an important role in chronic cough [1,2,3]
Some studies estimate between 10% and 40% of chronic cough is related to GORD [4, 5]
Our findings indicate that heartburn is the only significant predictor of success of acid suppression therapy when treating chronic cough in a ‘real-life’ setting
Summary
Gastro-oesophageal reflux disease (GORD) is thought to play an important role in chronic cough [1,2,3]. Recent guidelines only recommend trials of acid-suppressant therapy in those with evidence of pathological reflux or heartburn. This is based on a retrospective analysis of pooled data from 9 randomised trials in patients thought to have extra-oesophageal symptoms of reflux, of which chronic cough was a subgroup [8]. This study suggested that therapeutic gain is most likely to be seen in those with abnormal 24-h pH monitoring or reported heartburn These studies were all small (the largest was n = 39 patients) and the total number of subjects in this analysis was only 163 and the predictive value of reflux symptoms and measures was not clear. We set out to investigate the real-world response rate of acid suppression treatment in patients attending two specialist cough clinics and in particular which factors predicted likelihood of success of treatment
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