Response of chronic cough to acid suppresive therapy in patients with gastroesophageal reflux disease

Epidemiological and physiological studies suggest an association between gastroesophageal reflux disease (GERD) and chronic cough. Gastroesophageal reflux induced cough (GERC), is a common cause of chronic cough and accounts for 5-41% of chronic cough. The purpose of this study was to assess the relationship between chronic cough and GERD, and to monitorized the response of chronic cough after 8 weeks of acid suppressive therapy. 87 consecutive patients, nonsmokers, immunocompetent, with chronic cough undiagnosed at least 6 weeks and clinical symptoms specific for GERD (heartburn and regurgitations) were prospectively recruited into this study. They were assessed by history, physical examination, chest radiograph, spirometry, reversibility to nebulised salbutamol, skin prick tests to common allergens and esophageal endoscopy. A clinical diagnosis was made and the patient had an 8-week trial of appropriate therapy with proton pump inhibitors (Omeprazole 20 mg o.d.) and prokinetic agents (Metoclopramide 30 mg t.i.d). In 68/87 (78.16%) cases reflux preceded respiratory symptoms. After treatment period 60 patients (68.96%), 42 female and 18 men were classified as responders (improvement of cough), in 27 cases (31.03%), 17 female and 10 men, respiratory symptoms persist unchanged, none of patients had aggravation of cough. After supplementary investigations there was find a final diagnosis in non responders patients. Conclusions: GERD is a common disorder related with chronic cough. The benefits of acid-suppressive therapy in chronic cough patients cannot be dismissed, in terms of therapeutic effect and also for usefulness in differential diagnosis of chronic cough.