Gastroenterology
Volume 139, Issue 3 , Pages 754-762 , September 2010

Acoustic Cough—Reflux Associations in Chronic Cough: Potential Triggers and Mechanisms

  • Jaclyn A. Smith

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
    • Corresponding Author InformationReprint requests Address requests for reprints to: Jacky Smith, PhD, MRCP, Education and Research Centre, 2nd Floor, University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, United Kingdom. fax (44) 161 291 5730
  • ,
  • Samantha Decalmer

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
  • ,
  • Angela Kelsall

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
    • University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
  • ,
  • Kevin McGuinness

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
    • University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
  • ,
  • Helen Jones

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
  • ,
  • Simon Galloway

      Affiliations

    • University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
  • ,
  • Ashley Woodcock

      Affiliations

    • Respiratory Research Group, The University of Manchester, Manchester, United Kingdom
    • University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
  • ,
  • Lesley A. Houghton

      Affiliations

    • University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
    • Neurogastroenterology Unit, The University of Manchester, Manchester, United Kingdom

Received 3 November 2009 ,Accepted 3 June 2010.

References 

  1. Schappert SM, Burt CW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–2002. Vital Health Stat 13. 2006;159:1–66
  2. Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371:1364–1374
  3. Morice AH, McGarvey L, Pavord I. Recommendations for the management of cough in adults. Thorax. 2006;61(Suppl 1):i1–i24
  4. French CL, Irwin RS, Curley FJ, et al. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158:1657–1661
  5. Irwin RS, Corrao WM, Pratter MR. Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis. 1981;123:413–417
  6. Haque RA, Usmani OS, Barnes PJ. Chronic idiopathic cough: a discrete clinical entity?. Chest. 2005;127:1710–1713
  7. Jaspersen D, Diehl KL, Geyer P, et al. Omeprazole in reflux-associated chronic persistent cough. Endoskopie Heute. 1999;12:12–14
  8. Ours TM, Kavuru MS, Schilz RJ, et al. A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol. 1999;94:3131–3138
  9. Eherer AJ, Habermann W, Hammer HF, et al. Effect of pantoprazole on the course of reflux-associated laryngitis: a placebo-controlled double-blind crossover study. Scand J Gastroenterol. 2003;38:462–467
  10. Ing A. Chronic cough. Respirology. 1997;2:309–316
  11. Chang AB, Lasserson TJ, Kiljander TO, et al. Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ. 2006;332:11–17
  12. Ing A, Ngu MC, Breslin AB. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med. 1994;149:160–167
  13. Javorkova N, Varechova S, Pecova R, et al. Acidification of the oesophagus acutely increases the cough sensitivity in patients with gastro-esophageal reflux and chronic cough. Neurogastroenterol Motil. 2008;20:119–124
  14. Young EC, Decalmer S, Galloway S, et al. The majority of chronic cough patients exhibit evidence of oesophageal inflammation (abstract). Am J Respir Crit Care Med. 2009;179:A5761
  15. Wallaert B, Desreumaux P, Copin MC, et al. Immunoreactivity for interleukin 3 and 5 and granulocyte/macrophage colony-stimulating factor of intestinal mucosa in bronchial asthma. J Exp Med. 1995;182:1897–1904
  16. Blondeau K, Dupont LJ, Mertens V, et al. Improved diagnosis of gastro-oesophageal reflux in patients with unexplained chronic cough. Aliment Pharmacol Ther. 2007;25:723–732
  17. Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24-hour pressure, pH, and impedance monitoring. Gut. 2005;54:449–454
  18. Bogte A, Bredenoord AJ, Smout AJ. Diagnostic yield of oesophageal pH monitoring in patients with chronic unexplained cough. Scand J Gastroenterol. 2008;43:13–19
  19. Wunderlich AW, Murray JA. Temporal correlation between chronic cough and gastroesophageal reflux disease. Dig Dis Sci. 2003;48:1050–1056
  20. Patterson N, Mainie I, Rafferty G, et al. Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol. 2009;43:414–419
  21. Tutuian R, Mainie I, Agrawal A, et al. Nonacid reflux in patients with chronic cough on acid-suppressive therapy. Chest. 2006;130:386–391
  22. Mainie I, Tutuian R, Agrawal A, et al. Fundoplication eliminates chronic cough due to nonacid reflux identified by impedance pH monitoring. Thorax. 2005;60:521–523
  23. Agrawal A, Roberts J, Sharma N, et al. Symptoms with acid and nonacid reflux may be produced by different mechanisms. Dis Esophagus. 2009;22:467–470
  24. Avidan B, Sonnenberg A, Schnell TG, et al. Temporal associations between coughing or wheezing and acid reflux in asthmatics. Gut. 2001;49:767–772
  25. Schnatz PF, Castell JA, Castell DO. Pulmonary symptoms associated with gastroesophageal reflux: use of ambulatory pH monitoring to diagnose and to direct therapy. Am J Gastroenterol. 1996;91:1715–1718
  26. Paterson WG, Murat BW. Combined ambulatory esophageal manometry and dual-probe pH-metry in evaluation of patients with chronic unexplained cough. Dig Dis Sci. 1994;39:1117–1125
  27. Morice AH, Fontana GA, Sovijarvi AR, et al. The diagnosis and management of chronic cough. Eur Respir J. 2004;24:481–492
  28. Houghton LA, Atkinson W, Whorwell PJ, et al. Effects of cilomilast, a selective phosphodiesterase 4 inhibitor, on esophageal motility and pH, and orocecal and colonic transit: two single-center, randomized, double-blind, placebo-controlled, two-part crossover studies in healthy volunteers. Clin Ther. 2006;28:569–581
  29. Brightling CE, Ward R, Goh KL, et al. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999;160:406–410
  30. Smith JA, Earis JE, Woodcock AA. Establishing a gold standard for manual cough counting: video versus digital audio recordings. Cough. 2006;2:6
  31. Kelsall A, Decalmer S, Webster D, et al. How to quantify coughing: correlations with quality of life in chronic cough. Eur Respir J. 2008;32:175–179
  32. Morice AH, Fontana GA, Belvisi MG, et al. ERS guidelines on the assessment of cough. Eur Respir J. 2007;29:1256–1276
  33. Shay S, Tutuian R, Sifrim D, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–1043
  34. Zerbib F, des Varannes SB, Roman S, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–1021
  35. Weusten BL, Roelofs JM, Akkermans LM, et al. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology. 1994;107:1741–1745
  36. Lam HG, Breumelhof R, Roelofs JM, et al. What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data?. Dig Dis Sci. 1994;39:402–409
  37. Stovold R, Forrest IA, Corris PA, et al. Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. Am J Respir Crit Care Med. 2007;175:1298–1303
  38. Mainie I, Tutuian R, Agrawal A, et al. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg. 2006;93:1483–1487
  39. Penagini R, Schoeman MN, Dent J, et al. Motor events underlying gastro-oesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil. 1996;8:131–141
  40. Schoeman MN, Tippett MD, Akkermans LM, et al. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology. 1995;108:83–91
  41. van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119:1439–1446
  42. McGarvey L, McKeagney P, Polley L, et al. Are there clinical features of a sensitized cough reflex?. Pulm Pharmacol Ther. 2009;22:59–64
  43. Decalmer SC, Webster D, Kelsall AA, et al. Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring?. Thorax. 2007;62:329–334
  44. Kelsall A, Decalmer S, McGuinness K, et al. Sex differences and predictors of objective cough frequency in chronic cough. Thorax. 2009;64:393–398
  45. Dent J. Reflux inhibitor drugs: an emerging novel therapy for gastroesophageal reflux disease. J Dig Dis. 2010;11:72–75

 View this article's video abstract at www.gastrojournal.org

 Conflicts of interest The authors disclose the following: Dr J. A. Smith has received remuneration for advice, and the department has also received financial support from GlaxoSmithKline, Pfizer, Schering Plough, Procter & Gamble, Vectura, and Sound Biotech. Professor A. Woodcock has received remuneration for advice, and the department has also received financial support from GlaxoSmithKline, Schering Plough, Astra Zeneca, and Chiesi Pharmaceutici. Dr L. A. Houghton has received remuneration for advice, and the department has also received financial support from Novartis Pharmaceuticals, GlaxoSmithKline, Pfizer, Solvay Pharmaceuticals, Danone Research, Clasado Ltd, Norgine, Kellogg's UK, and Ono Pharma UK Ltd. The remaining authors disclose no conflicts.

 Funding Supported by the Moulton Charitable Trust and by a Stepping Stones Award from the University of Manchester (to J.A.S.).

PII: S0016-5085(10)00959-5

doi: 10.1053/j.gastro.2010.06.050

Gastroenterology
Volume 139, Issue 3 , Pages 754-762 , September 2010