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Sha B, Li W, Bai H, Zhang T, Wang S, Shi W, Wen S, Yu L, Xu X. How to diagnose GERC more effectively: reflections on post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance. BMC Pulm Med 2024; 24:269. [PMID: 38840152 PMCID: PMC11155067 DOI: 10.1186/s12890-024-03080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI) are novel parameters reflect esophageal clearance capacity and mucosal integrity. They hold potential in aiding the recognition of gastroesophageal reflux-induced chronic cough (GERC). Our study aims to investigate their diagnostic value in GERC. METHODS This study included patients suspected GERC. General information and relevant laboratory examinations were collected, and final diagnosis were determined following guidelines for chronic cough. The parameters of multichannel intraluminal impedance-pH monitoring (MII-pH) in patients were analyzed and compared to explore their diagnostic value in GERC. RESULTS A total of 186 patients were enrolled in this study. The diagnostic value of PSPWI for GERC was significant, with the area under the working curve (AUC) of 0.757 and a cutoff value of 39.4%, which was not statistically different from that of acid exposure time (AET) (p > 0.05). The combined diagnostic value of AET > 4.4% and PSPWI < 39.4% was superior to using AET > 4.4% alone (p < 0.05). Additionally, MNBI and distal MNBI also contributed to the diagnosis of GERC, with AUC values of 0.639 and 0.624, respectively. AET > 4.4% or PSPWI < 39.4% is associated with a 44% reduction in missed diagnoses of non-acid GERC compared to AET > 6.0% or symptom association probability (SAP) ≥ 95%, and may be more favorable for identifying GERC. CONCLUSION The diagnostic value of PSPWI for GERC is comparable to that of AET. Combining PSPWI < 39.4% or AET > 4.4% can improve the diagnostic efficiency by reducing the risk of missed diagnoses in cases where non-acid reflux is predominant. Distal MNBI and MNBI can serve as secondary reference indices in the diagnosis of GERC.
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Affiliation(s)
- Bingxian Sha
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wanzhen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haodong Bai
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tongyangzi Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenbo Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Siwan Wen
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
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Floria DE, Obeidat M, Kávási SB, Teutsch B, Veres DS, Hagymási K, Hegyi P, Drug VL, Erőss B. Systematic review and meta-analysis: proton pump inhibitors slightly decrease the severity of chronic cough. Sci Rep 2024; 14:11956. [PMID: 38796481 PMCID: PMC11127940 DOI: 10.1038/s41598-024-62640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the effects of acid-suppressive medications in adults with non-specific chronic cough. The protocol was registered on PROSPERO (CRD42022368769). Placebo-controlled randomized trials evaluating the impact of acid-suppressive medications on persistent cough were included. The systematic search was performed on the 1st of November 2022 in three databases. A random-effects model was used for the calculations. The effect size was the standardized mean difference (SMD) with 95% confidence interval (CI). A total number of 11 double-blinded placebo-controlled randomized trials were included in the meta-analysis. Data showed that compared to placebo, PPIs decreased the severity of cough (SMD 0.33; CI 0.05; 0.61). Therapeutic response was not different in patients with non-specific chronic cough only, compared to those with laryngopharyngeal reflux. Prolonged treatment durations did not result in greater symptomatic improvement, with SMD 0.33 (CI - 0.22; 0.88), 0.31 (CI - 1.74; 2.35), 0.32 (CI - 0.29; 0.93) and 0.34 (CI - 0.16; 0.85), following 4, 6, 8 and 12 weeks of treatment, respectively. The pooled analysis of the improvement in quality of life with PPIs found an SMD of 0.39 (CI - 0.51; 1.29). PPIs mildly decrease the severity of non-specific chronic cough, irrespective of treatment duration.
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Affiliation(s)
- Diana-Elena Floria
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Grigore T. Popa University of Medicine and Pharmacy Iaşi, University Street 16, Iaşi, 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon Emergency Hospital Iaşi, Independence Boulevard 1, Iaşi, 700111, Romania
| | - Mahmoud Obeidat
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Sarolta Beáta Kávási
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Department of Surgery, Toldy Ferenc Hospital, Cegléd, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Krisztina Hagymási
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Vasile-Liviu Drug
- Grigore T. Popa University of Medicine and Pharmacy Iaşi, University Street 16, Iaşi, 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon Emergency Hospital Iaşi, Independence Boulevard 1, Iaşi, 700111, Romania
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, Budapest, 1085, Hungary.
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary.
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
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Ribolsi M, De Bortoli N, Frazzoni M, Marchetti L, Savarino E, Cicala M. Proximal esophageal impedance baseline increases the yield of impedance-pH and is associated with response to PPIs in chronic cough patients. Neurogastroenterol Motil 2024; 36:e14775. [PMID: 38424679 DOI: 10.1111/nmo.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Chronic cough significantly impairs the quality of life. Although various studies focused on MNBI as assessed in the distal esophagus, scarce data are available on the clinical value of proximal measurements. AIM To investigate the role of proximal MNBI in the workup of patients with chronic cough and its ability to predict PPI response. METHODS Demographic, clinical, endoscopy findings, impedance-pH and HRM tracings from consecutive cough patients were evaluated. MNBI was calculated at proximal and distal esophagus. RESULTS One hundred and sixty four patients were included. In addition to traditional variables, when considering also the PSPW index or MNBI at 3 cm or 15 cm, the proportion of patients with pathological impedance-pH monitoring significantly increased. 70/164 patients were responders, while 94 (57.3%) were non-responder to double PPI dose (p < 0.05). Patients with pathologic MNBI at 3 cm and/or 15 cm as well as those with pathologic PSPW index were characterized by a significantly higher proportion of responders than that observed among patients with normal impedance-pH variables (p < 0.001). The proportion of responders with pathological MNBI at 15 cm was significantly higher than the proportion of responders with pathological MNBI at 3 cm (82.8% vs. 64.3%, p < 0.05). At multivariable model, pathological MNBI at both 3 cm and 15 cm as well as PSPW index were associated with PPI responsiveness. The strongest association with PPI response was observed for MNBI at 15 cm. CONCLUSIONS The assessment of MNBI at proximal esophagus increases the diagnostic yield of impedance-pH monitoring and may represent a useful predictor of PPI responsiveness in the cumbersome clinical setting of suspected reflux-related cough.
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Affiliation(s)
- Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Nicola De Bortoli
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Lorenzo Marchetti
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua School of Medicine and Surgery, Padova, Italy
| | - Michele Cicala
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
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Hránková V, Balner T, Gubová P, Staníková L, Zeleník K, Komínek P. Narrative review of relationship between chronic cough and laryngopharyngeal reflux. Front Med (Lausanne) 2024; 11:1348985. [PMID: 38707186 PMCID: PMC11066273 DOI: 10.3389/fmed.2024.1348985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) as a possible cause of chronic cough is known for decades. However, more than 75% of patients with extraoesophageal symptoms do not suffer from typical symptoms of GERD like pyrosis and regurgitations and have negative upper gastrointestinal endoscopy. For such a condition term laryngopharyngeal reflux (LPR) was introduced and is used for more than two decades. Since the comprehensive information on relationship between chronic cough and LPR is missing the aim of this paper is to summarize current knowledge based on review of published information during last 13 years. Laryngopharyngeal reflux is found in 20% of patients with chronic cough. The main and recognized diagnostic method for LPR is 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, revealing reflux episodes irritating the upper and lower respiratory tract mucosa. The treatment of LPR should be initiated with dietary and lifestyle measures, followed by proton pump inhibitor (PPI) therapy and other measures. Despite progress, more research is needed for accurate diagnosis and targeted therapies. Key areas for exploration include biomarkers for diagnosis, the impact of non-acid reflux on symptom development, and the efficacy of new drugs. Further studies with a focused population, excluding other causes like asthma, and using new diagnostic criteria for LPR are essential. It's crucial to consider LPR as a potential cause of unexplained chronic cough and to approach diagnosis and treatment with a multidisciplinary perspective.
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Affiliation(s)
- Viktória Hránková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Tomáš Balner
- Department of Allergology and Clinical Immunology, University Hospital of Ostrava, Ostrava, Czechia
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Patrícia Gubová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czechia
| | - Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
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Zhong S, Zhong M, Fang L, Zhi H, Ji X, Tang K, Zhan C, Shi X, Xian M, Wang W, Li J, Luo W, Lai K, Chen R. Potassium-Competitive Acid Blocker Versus Proton Pump Inhibitor: A Pilot Study on Comparable Efficacy in the Treatment of Gastroesophageal Reflux-Related Cough. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:191-201. [PMID: 38528386 DOI: 10.4168/aair.2024.16.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 03/27/2024]
Abstract
Acid inhibitors have been considered in treating gastroesophageal reflux-related cough (GERC). Compared to proton pump inhibitors (PPIs), potassium-competitive acid blockers (P-CABs) have more potent and durable effects on anti-acid secretion. However, whether vonoprazan and esomeprazole have different therapeutic effects on GERC remains unknown. Patients diagnosed with GERC were enrolled in our study and randomly treated with vonoprazan (20 mg, once daily, P-CAB) or esomeprazole (20 mg, twice daily, PPI) for two months. A prokinetic agent was also administered. Patients were followed up once a month. Cough severity visual analogue scale (VAS) was measured as the primary outcome, while cough symptom score (CSS) and scores for cough-related quality-of-life or reflux-related symptoms were the secondary endpoints. A total of 50 patients completed the study, with 25 patients in each group. P-CAB and PPI groups showed similar decreases in cough severity VAS and CSS scores after the 2-month treatment (all P < 0.001). For quality-of-life, the Leicester Cough Questionnaire (LCQ) score increased significantly from baseline in both groups, but the P-CAB group had greater improvement and a higher LCQ score in month 2 (all P ≤ 0.05). For reflux-related symptoms, the Hull Airway Reflux Questionnaire (HARQ) score declined substantially over time in the P-CAB group, while the reflux symptom index (RSI) score decreased in both groups. The P-CAB group tended to have a lower HARQ (P = 0.051) and RSI (P = 0.069) scores in month 2. In conclusion, vonoprazan may be comparable to esomeprazole in cough symptom relief in GERC during the 2-month treatment period, but possibly provides better gains on classic reflux symptoms and quality-of-life. The long-term efficacy of P-CABs on GERC may be worth further exploration. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2200067089.
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Affiliation(s)
- Shuxin Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyu Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liman Fang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haopeng Zhi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaolong Ji
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kailun Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chen Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xu Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mo Xian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wanjun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Ruchong Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Marchant JM, Chang AB, Kennedy E, King D, Perret JL, Schultz A, Toombs MR, Versteegh L, Dharmage SC, Dingle R, Fitzerlakey N, George J, Holland A, Rigby D, Mann J, Mazzone S, O'Brien M, O'Grady KA, Petsky HL, Pham J, Smith SM, Wurzel DF, Vertigan AE, Wark P. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust 2024; 220:35-45. [PMID: 37982357 DOI: 10.5694/mja2.52157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Emma Kennedy
- Rural and Remote Health, Flinders University, Darwin, NT
| | | | - Jennifer L Perret
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Perth, WA
- Perth Children's Hospital, Perth, WA
| | | | | | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | | | | | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Anne Holland
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
| | - Debbie Rigby
- University of Queensland, Brisbane, QLD
- Queensland University of Technology, Brisbane, QLD
| | - Jennifer Mann
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | | | | | - Kerry-Ann O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
| | | | | | | | | | - Anne E Vertigan
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
| | - Peter Wark
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
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Sha B, Li W, Bai H, Zhang T, Wang S, Wu L, Shi W, Zhu Y, Yu L, Xu X. Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough. Ther Adv Respir Dis 2024; 18:17534666231220819. [PMID: 38183263 PMCID: PMC10771752 DOI: 10.1177/17534666231220819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The current available diagnostic criteria for gastroesophageal reflux-related chronic cough (GERC) dominated by non-acid reflux is imperfect. The post-reflux swallow-induced peristaltic wave index (PSPWI) is a parameter reflecting esophageal clearance function. OBJECTIVES This study aims to investigate its diagnostic value for non-acid GERC. DESIGN This study sought to compare the diagnostic value of PSPWI in different types of GERC, particularly non-acid GERC, and explore the clinical significance of PSPWI in the diagnosis of non-acid GERC through diagnostic experiments. METHODS A retrospective analysis was performed based on 223 patients with suspected GERC who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) in the outpatient clinic of our department from August 2016 to June 2021. Their clinical information, laboratory test results, and treatment responses were assessed and the underlying etiologies of chronic cough were categorized. The predictive value of the PSPWI in diagnosing different types of GERC, especially non-acid GERC, was analyzed and compared. RESULTS A total of 195 patients with chronic cough who met the inclusion criteria underwent MII-pH monitoring. 143 patients had a definitive diagnosis of GERC, including 98 with acid GERC and 45 with non-acid GERC. The diagnostic value of PSPWI alone was moderate for GERC with an area under the working curve (AUC) 0.760, but poor for non-acid GERC with an AUC of 0.569. However, PSPWI < 39.8% combining with acid exposure time (AET) ⩽ 6.2% demonstrated a moderate diagnostic value for non-acid GERC, with an AUC of 0.722. When PSPWI < 39.8% combined with a non-acid reflux ratio >68.75%, the diagnostic value for non-acid GERC was improved (AUCROC = 0.80 versus AUCROC = 0.722, p < 0.05), which was significantly superior to non-acid symptom index (AUCROC = 0.804 versus AUCROC = 0.550, p < 0.05) and non-acid symptom association probability (AUCROC = 0.804 versus AUCROC = 0.571, p < 0.05). CONCLUSION PSPWI < 39.8% and AET ⩽ 6.2% have demonstrated good diagnostic value for non-acid GERC. The diagnostic value was further improved when combined with non-acid reflux ratio >68.75%.
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Affiliation(s)
- Bingxian Sha
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wanzhen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haodong Bai
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tongyangzi Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Linyang Wu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenbo Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai 200065, China
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Li W, Zhang T, Gu W, Shi W, Wang S, Zhu Y, Shi C, Yu L, Xu X. A comparison between a gastroesophageal reflux disease questionnaire-based algorithm and multichannel intraluminal impedance-pH monitoring for the treatment of gastroesophageal reflux-induced chronic cough. Ther Adv Respir Dis 2024; 18:17534666231220817. [PMID: 38183243 PMCID: PMC10771753 DOI: 10.1177/17534666231220817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Empiric therapy with multichannel intraluminal impedance-pH monitoring (MII-pH) has been used for the initial treatment of gastroesophageal reflux-induced chronic cough (GERC). However, an algorithm based on the gastroesophageal reflux disease questionnaire (GerdQ) has the potential to achieve a simple, structured, and effective treatment approach for patients with GERC. OBJECTIVES This study compared the efficacy of anti-reflux therapy based on GerdQ (new structured pathway, NSP) with medical treatment after MII-pH examination (ordinary clinical pathway, OCP) in the management of GERC. DESIGN For the NSP, we adapted the GerdQ score to establish the basis for a treatment algorithm. For the OCP, treatment was determined using the MII-pH examination results. METHODS The non-inferiority (NI) hypothesis was used to evaluate NSP versus OCP. RESULTS Overall, the NSP and OCP-based therapeutic algorithms have similar efficacy for GERC [NI analysis: 95% confidence interval (CI), -4.97 to 17.73, p = 0.009; superiority analysis: p = 0.420]. Moreover, the cough symptom scores and cough threshold improved faster in the NSP group than in the OCP group at week 8 (p < 0.05). In the subgroup analyses using the GerdQ and GerdQ impact scale (GIS) scores, patients with low-likelihood GERC (GerdQ < 8) were more likely to benefit from OCP (NI analysis: 95% CI, -19.73 to 18.02, p = 0.213). On the other hand, in patients with high-likelihood and low-reflux impact GERC patients (GerdQ > 8 and GIS < 4), the NSP arm was not inferior to the standard treatment of OCP (NI analysis: 95% CI, -8.85 to 28.21%, p = 0.04; superiority analysis: p = 0.339), indicating that GerdQ- and GIS-guided diagnosis and management of patients with GERC could be an alternative to MII-pH management, especially in settings with reduced medical resources. CONCLUSIONS The use of the GerdQ algorithm should be considered when handling patients with GERC in the primary care setting. TRIAL REGISTRATION This research was registered in the Chinese Clinical Trials Registry (ChiCTR-ODT-12001899).
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Affiliation(s)
- Wanzhen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tongyangzi Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenhua Gu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenbo Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Cuiqin Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai 200065, China
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9
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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10
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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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11
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Fossmark R, Ness-Jensen E, Sørdal Ø. Is empiric proton pump inhibition in patients with symptoms of extraesophageal gastroesophageal reflux justified? BMC Gastroenterol 2023; 23:303. [PMID: 37674110 PMCID: PMC10483799 DOI: 10.1186/s12876-023-02945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) has had a marked increase in Western countries with a paralleling interest in extraesophageal (EE) manifestations of GERD, including laryngopharyngeal reflux (LPR). There are considerable differences in clinical practice between gastroenterologists, otolaryngologists and pulmonologists. METHODS In this narrative review we address some of these controversies concerning EE manifestations of GERD and LPR. RESULTS It is disputed whether there is causal relationship between reflux and the numerous symptoms and conditions suggested to be EE manifestations of GERD. Similarly, the pathophysiology is uncertain and there are disagreements concerning diagnostic criteria. Consequently, it is challenging to provide evidence-based treatment recommendations. A significant number of patients are given a trial course with a proton pump inhibitor (PPI) for several months before symptoms are evaluated. In randomized controlled trials (RCTs) and meta-analyses of RCTs PPI treatment does not seem to be advantageous over placebo, and the evidence supporting that patients without verified GERD have any benefit of PPI treatment is negligible. There is a large increase in both over the counter and prescribed PPI use in several countries and a significant proportion of this use is without any symptomatic benefit for the patients. Whereas short-term treatment has few side effects, there is concern about side-effects after long-term use. Although empiric PPI treatment for suspected EE manifestations of GERD instead of prior esophageal 24-hour pH and impedance monitoring is included in several guidelines by various societies, this practice contributes to overtreatment with PPI. CONCLUSION We argue that the current knowledge suggests that diagnostic testing with pH and impedance monitoring rather than empiric PPI treatment should be chosen in a higher proportion of patients presenting with symptoms possibly attributable to EE reflux.
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Affiliation(s)
- Reidar Fossmark
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Prinsesse Kristinas gate 1, Trondheim, 7030, Norway.
- Medicus Endoscopy, Trondheim, Norway.
| | - Eivind Ness-Jensen
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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12
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Chen G, Gong X, Liu S, Xie J, Wang Y, Guo W, Liao W, Song L, Zhang X. Causal analysis between gastro-oesophageal reflux disease and obstructive sleep apnoea. ERJ Open Res 2023; 9:00127-2023. [PMID: 37650083 PMCID: PMC10463038 DOI: 10.1183/23120541.00127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/28/2023] [Indexed: 09/01/2023] Open
Abstract
Background Based on evidence from existing observational research, clarifying the causal relationship between gastro-oesophageal reflux disease (GORD) and obstructive sleep apnoea (OSA) is challenging. Here, Mendelian randomisation, a method based on genetics, was used to provide new evidence for causality. Methods Summary statistics from two publicly available genome-wide association studies were used to evaluate the causal relationship between GORD and OSA (the GORD database was used as an exposure variable and the OSA database as an outcome). Inverse variance weighting was used as the main analytical tool in Mendelian randomisation to estimate causal effects. The robustness of the results was evaluated by sensitivity analysis. Possible mediators were evaluated using multivariate Mendelian randomisation. Results A statistically significant causal relationship was observed between GORD and OSA (OR 1.597, 95% CI 1.401-1.821, p<0.001), and similar results were observed in weighted median and Mendelian randomisation-Egger regression analyses. No bias was found in the sensitivity analysis of Mendelian randomisation estimation. Multivariate Mendelian randomisation showed that GORD significantly increased the risk of developing OSA, even when the possible mediator was excluded (OR 1.107, 95% CI 1.101-1.212, p<0.001). Conclusion Our study confirmed a causal relationship between GORD and OSA and suggests that intervention measures should be taken for patients with GORD to prevent the occurrence of OSA.
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Affiliation(s)
- Gui Chen
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- These authors contributed equally
| | - Xin Gong
- Department of Otolaryngology – Head and Neck Surgery, Wushan County People's Hospital of Chongqing, Wushan, China
- These authors contributed equally
| | - Shenrong Liu
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyang Xie
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingqi Wang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wucheng Guo
- Department of Stomatology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Liao
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijuan Song
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology – Head and Neck Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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13
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S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:862-933. [PMID: 37494073 DOI: 10.1055/a-2060-1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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14
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Guilleminault L, Demoulin-Alexikova S, de Gabory L, Varannes SBD, Brouquières D, Balaguer M, Chapron A, Grassin-Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. Guidelines for the management of chronic cough in adults. Endorsed by the French speaking society of respiratory diseases (Société de Pneumologie de Langue Française, SPLF), the Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), the Société Française de Phoniatrie et de Laryngologie (SFPL), the Société Nationale Française de Gastro-entérologie (SNFGE). Respir Med Res 2023; 83:101011. [PMID: 37087905 DOI: 10.1016/j.resmer.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
Patients with chronic cough experience a high alteration of quality of life. Moreover, chronic cough is a complex entity with numerous etiologies and treatments. In order to help clinicians involved in the management of patients with chronic cough, guidelines on chronic cough have been established by a group of French experts. These guidelines address the definitions of chronic cough and the initial management of patients with chronic cough. We present herein second-line tests that might be considered in patients with cough persistence despite initial management. Experts also propose a definition of unexplained or refractory chronic cough (URCC) in order to better identify patients whose cough persists despite optimal management. Finally, these guidelines address the pharmacological and non-pharmacological interventions useful in URCC. Thus, amitryptilline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are a mainstay of treatment strategies in URCC. Other treatment options, such as P2 × 3 antagonists, are being developed.
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Affiliation(s)
- Laurent Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, 31000, Toulouse, France.
| | - Silvia Demoulin-Alexikova
- CHU de Lille, Lille, France Univ. Lille, CNRS, Inserm, CHU Lille - Service des Explorations Fonctionnelles Respiratoires, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, 59000, Lille, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, Univ. Bordeaux, 33000, France
| | - Stanislas Bruley Des Varannes
- Gastroenterology Department, CHU de Nantes, Institut des Maladies de l'Appareil Digestif, IMAD CIC 1413, Université de Nantes, 44000, Nantes, France
| | - Danielle Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | - Mathieu Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Anthony Chapron
- Université de Rennes 1, CHU Rennes, Département de Médecine Générale, 35000, Rennes, France
| | - Stanislas Grassin-Delyle
- Respiratory Diseases Department, Foch Hospital, 92150, Suresnes, France; Infection and Inflammation, Health Biotechnology Department, Paris-Saclay University, UVSQ, INSERM, 78180, Montigny le Bretonneux, France
| | - Mathias Poussel
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire-Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000, Nancy, France; DevAH, Université de Lorraine, F54000, Nancy, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, 49000, Angers, France
| | - Virginie Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Sabine Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
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15
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Guilleminault L, Demoulin-Alexikova S, de Gabory L, Bruley des Varannes S, Brouquières D, Balaguer M, Chapron A, Grassin Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. [Guidelines for the management of chronic cough in adults]. Rev Mal Respir 2023; 40:432-452. [PMID: 37080877 DOI: 10.1016/j.rmr.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/22/2023]
Abstract
Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.
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Affiliation(s)
- L Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, université de Toulouse III, Toulouse, France.
| | - S Demoulin-Alexikova
- CHU de Lille, Lille, France; Inserm, CNRS, U1019-UMR9017, service des explorations fonctionnelles respiratoires, centre d'infection et d'immunité de Lille (CIIL), Institut Pasteur de Lille, university Lille, CHU Lille, Lille, France
| | - L de Gabory
- Department of otorhinolaryngology - head and neck surgery, university hospital of Bordeaux, Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - S Bruley des Varannes
- IMAD CIC 1413, gastroenterology department, Institut des maladies de l'appareil digestif, université de Nantes, CHU de Nantes, Nantes, France
| | - D Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - M Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - A Chapron
- Département de médecine générale, université de Rennes 1, CHU Rennes, Rennes, France
| | - S Grassin Delyle
- Respiratory diseases department, Foch hospital, Suresnes, France; Inserm, UVSQ, infection and inflammation, health biotechnology department, Paris-Saclay university, Montigny-le-Bretonneux, France
| | - M Poussel
- Exploration fonctionnelle respiratoire, centre universitaire de médecine du sport et activités physiques adaptées, CHRU de Nancy, 54000 Nancy, France; DevAH, université de Lorraine, 54000 Nancy, France
| | - N Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - G Reychler
- Université catholique de Louvain, Louvain, Belgique
| | - W Trzepizur
- Department of respiratory and sleep medicine, Angers university hospital, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, équipe CarME, SFR ICAT, university of Angers, 49000 Angers, France
| | - V Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - S Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
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16
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Zhang L, Aierken A, Zhang M, Qiu Z. Pathogenesis and management of gastroesophageal reflux disease-associated cough: a narrative review. J Thorac Dis 2023; 15:2314-2323. [PMID: 37197515 PMCID: PMC10183548 DOI: 10.21037/jtd-22-1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
Background and Objective Gastroesophageal reflux disease (GERD)-associated cough is defined as a special GERD with a predominant cough symptom and is a common cause of chronic cough. This review summarizes our current understanding on the pathogenesis and management of GERD-associated cough. Methods Main literatures on the pathogenesis and management of GERD-associated cough were reviewed and our understandings derived from the published studies were showed then. Key Content and Findings Although esophageal-tracheobronchial reflex mainly underlies the pathogenesis of GERD-associated cough, its counterpart-tracheobronchial-esophageal reflex might exist and initiate the cough due to reflux induced by upper respiratory tract infection through the signaling of transient receptor potential vanilloid 1 linking airway and esophagus. The presence of reflux-associated symptoms such as regurgitation and heartburn along with coughing suggests an association between cough and GERD, which is supported by the objective evidence of abnormal reflux as detected by reflux monitoring. Although there is no general consensus, esophageal reflux monitoring provides the main diagnostic criteria for GERD-associated cough. Despite that acid exposure time and symptom associated probability are useful and mostly employed reflux diagnostic criteria, they are imperfect and far from being the gold standard. Acid suppressive therapy has long been recommended as the first choice for GERD-associated cough. However, the overall benefits of proton pump inhibitors have been controversial and need to be further assessed, especially in patients with cough due to non-acid reflux. Neuromodulators have demonstrated potential therapeutic effects for refractory GERD-associated cough, for which anti-reflux surgery may also be a promising treatment option. Conclusions Tracheobronchial-esophageal reflex might initiate reflux-induced cough provoked by the upper respiratory tract infection. It is necessary to optimize the current standards and to explore new criteria with higher diagnostic potency. Acid suppressive therapy is the first choice for GERD-associated cough, followed by neuromodulators and anti-reflux surgery for refractory GERD-associated cough.
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Affiliation(s)
- Li Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Alimire Aierken
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Zhu Y, Zhang T, Wang S, Li W, Shi W, Bai X, Sha B, Zhang M, Wen S, Shi C, Xu X, Yu L. Mean Nocturnal Baseline Impedance (MNBI) Provides Evidence for Standardized Management Algorithms of Nonacid Gastroesophageal Reflux-Induced Chronic Cough. Int J Clin Pract 2023; 2023:7992062. [PMID: 36941872 PMCID: PMC10024619 DOI: 10.1155/2023/7992062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/03/2023] [Accepted: 02/11/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The clinical management of nonacid gastroesophageal reflux-induced chronic cough (GERC) is challenging, and patient response to standard antireflux therapy (omeprazole 20 mg twice daily plus mosapride 10 mg thrice daily) is suboptimal. This study aimed to identify predictors of standard antireflux therapy efficacy and provide evidence for standardized management algorithms of nonacid GERC. METHODS A total of 115 nonacid GERC patients who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) were enrolled between March 2017 and March 2021. Retrospective analysis of general information and MII-pH indications were used to establish a regression analysis model for multiple factors affecting standard antireflux therapy efficacy. RESULTS 90 patients met the inclusion criteria, and the overall response rate to standard antireflux therapy was 55.5% (50/90). The mean nocturnal baseline impedance (MNBI) (1817.75 ± 259.26 vs. 2369.93 ± 326.35, P = 0.030) and proximal MNBI (1833.39 ± 92.16 vs. 2742.57 ± 204.64, P ≤ 0.001) of responders were lower than those of nonresponders. Weakly acid reflux (56.00 (31.70, 86.00) vs. 14.00 (14.00, 44.20), P = 0.022), nonacid reflux (61.35 (15.90.86.50) vs. 21.60 (0.00, 52.50), P = 0.008), and proximal extent (19.00 (5.04, 24.00) vs. 5.50 (2.56, 11.13), P = 0.011) were markedly higher in responders than nonresponders. Proximal MNBI (OR = 0.997, P = 0.042, and optimal cutoff = 2140 Ω) and weakly acid reflux (OR = 1.051, P = 0.029, and optimal cutoff = 45) were independent predictors of standard antireflux therapy efficacy. The combination predictive value did not show better results than either individual predictor. CONCLUSIONS Proximal MNBI < 2140 Ω may be used to screen patients with nonacid GERC suitable for standard antireflux therapy and in standardized management algorithms for nonacid GERC. In the absence of MNBI, weakly acid reflux > 45 can be used as an auxiliary indicator.
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Affiliation(s)
- Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Tongyangzi Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Wanzhen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Wenbo Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Xiao Bai
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Bingxian Sha
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Siwan Wen
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Cuiqin Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
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Wu J, Ma Y, Chen Y. GERD-related chronic cough: Possible mechanism, diagnosis and treatment. Front Physiol 2022; 13:1005404. [PMID: 36338479 PMCID: PMC9630749 DOI: 10.3389/fphys.2022.1005404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2023] Open
Abstract
GERD, or gastroesophageal reflux disease, is a prevalent medical condition that affects millions of individuals throughout the world. Chronic cough is often caused by GERD, and chronic cough caused by GER is defined as GERD-related chronic cough (GERC). It is still unclear what the underlying molecular mechanism behind GERC is. Reflux theory, reflex theory, airway allergies, and the novel mechanism of esophageal motility disorders are all assumed to be linked to GERC. Multichannel intraluminal impedance combined with pH monitoring remains the gold standard for the diagnosis of GERC, but is not well tolerated by patients due to its invasive nature. Recent discoveries of new impedance markers and new techniques (mucosal impedance testing, salivary pepsin, real-time MRI and narrow band imaging) show promises in the diagnosis of GERD, but the role in GERC needs further investigation. Advances in pharmacological treatment include potassium-competitive acid blockers and neuromodulators (such as Baclofen and Gabapentin), prokinetics and herbal medicines, as well as non-pharmacological treatments (such as lifestyle changes and respiratory exercises). More options have been provided for the treatment of GERC other than acid suppression therapy and anti-reflux surgery. In this review, we attempt to review recent advances in GERC mechanism, diagnosis, and subsequent treatment options, so as to provide guidance for management of GERC.
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Affiliation(s)
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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19
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Tracheobronchial-esophageal reflex initiates esophageal hypersensitivity and aggravates cough hyperreactivity in guinea pigs with esophageal acid infusion. Respir Physiol Neurobiol 2022; 301:103890. [PMID: 35358761 DOI: 10.1016/j.resp.2022.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Esophageal-tracheobronchial reflex is considered the main mechanism underlying cough due to gastroesophageal reflux, and is associated with esophageal hypersensitivity. We hypothesized that tracheobronchial-esophageal reflex may also exist, and may be related to esophageal hypersensitivity. To test this hypothesis, conscious and ether-anesthetized guinea pigs were subjected to repetitive capsaicin inhalation to establish models of cough (conscious) and cough-free (anesthetized) airway injury, respectively, followed by esophageal acid infusion. Recurrent capsaicin inhalation induced similar cough hyperreactivity to inhaled capsaicin after esophageal acid infusion in guinea pigs with cough and guinea pigs with cough-free airway injury during recurrent capsaicin inhalation. Cough hyperreactivity, along with overexpression of transient receptor potential vanilloid 1 (TRPV1) receptors in esophageal mucosa and in nerve fibers of tracheal mucosa of guinea pigs were blocked by pretreatment with esophageal infusion of capsazepine, but not atropine. Thus, recurrent airway nociceptive stimuli induce esophageal hyperreactivity via a tracheobronchial-esophageal reflex mediated by vagal C afferents expressing TRPV1, and enhance cough due to reflux.
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20
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Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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21
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De Vincentis A, Baldi F, Calderazzo M, Caliceti U, Guarnieri G, Lombardi F, Lombardo FP, Maggi S, Onder G, Vaghi A, Zanasi A, Antonelli Incalzi R. Chronic cough in adults: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2022; 34:1529-1550. [PMID: 35666453 DOI: 10.1007/s40520-022-02154-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic cough (CC) is a burdensome health problem in adult and older people, with a major impact on quality of life. Its management is often troublesome, and many guidelines have been released. Notwithstanding, a proportion of cases still do not reach a definite diagnosis and resolutive treatment. A coordinated approach between different specialists would be highly recommended, but its implementation in clinical practice suffers from the lack of shared protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIMS To develop evidence-based recommendations for the management of adults with CC. METHODS A 12-member expert task force of general practitioners, geriatricians, pneumologists, allergologists, otorhynolaringologists and gastroenterologists was established to develop evidence-based recommendations for the diagnostic and therapeutic approach to subjects with CC. A modified Delphi approach was used to achieve consensus, and the US Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 56 recommendations were proposed, covering 28 topics and concerning definitions and epidemiology, pathogenesis and etiology, diagnostic and therapeutic approach along with the consideration of specific care settings. CONCLUSION These recommendations should ease the management of subjects with CC by coordinating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Affiliation(s)
- Antonio De Vincentis
- Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Fabio Baldi
- Gastroenterology and Digestive Pathophysiology, Villalba Hospital, Bologna, Italy
| | | | - Umberto Caliceti
- Emeritus Professor of Otorhinolaringology, Università di Bologna, Bologna, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Lombardi
- Fondazione Policlinico IRCCS A. Gemelli, and Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Paolo Lombardo
- General Practitioner, Società Italiana di Medicina Generale (SIMG), Pneumology Area, Florence, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Adriano Vaghi
- ASST-Rhodense, UOC Pneumologia, Garbagnate Milanese, Milan, Italy
| | | | - Raffaele Antonelli Incalzi
- Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, 00128, Rome, Italy
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22
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Badri H, Gibbard C, Denton D, Satia I, Al-Sheklly B, Dockry RJ, Holt K, McGuiness K, Treadway S, Whorwell P, Houghton L, Lee A, Escott KJ, Lee T, Wilkinson G, Holt A, Canning BJ, Smith JA. A double-blind randomised placebo-controlled trial investigating the effects of lesogaberan on the objective cough frequency and capsaicin evoked coughs in patients with refractory chronic cough. ERJ Open Res 2022; 8:00546-2021. [PMID: 35295236 PMCID: PMC8918934 DOI: 10.1183/23120541.00546-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/29/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Baclofen is a centrally acting γ-aminobutyric acid type B (GABAB) receptor agonist which reduces gastro-oesophageal reflux and suppresses the cough reflex; however, central nervous system side-effects limit its use. Lesogaberan is a novel peripherally acting GABAB agonist, but its effects on refractory chronic cough are unknown. Design We performed a single-centre, placebo-controlled, double-blind randomised crossover study in patients with chronic cough, refractory to the treatment of underlying conditions. Patients were randomised to treatment with lesogaberan 120 mg modified release twice daily or matched placebo for 2 weeks and then crossed over to the alternative therapy after a 2-week washout. The primary end-point was 24-h cough frequency measured with an acoustic monitoring system. In addition, cough responses to capsaicin were measured, and gastro-oesophageal reflux assessed by 24-h pH/impedance at screening. Results 22 patients were randomised to receive lesogaberan/placebo or placebo/lesogaberan (female (73%); mean±sd age 63.7±7.2 years; median (interquartile range) cough duration 10.5 (5.8–17.0) years; mean (95% CI) 45 (29–67) reflux events in 24 h; two patients had abnormal oesophageal acid exposure times). Although lesogaberan reduced cough counts by 26% over placebo, this did not reach statistical significance (p=0.12). However, lesogaberan did significantly improve cough responses to capsaicin (p=0.04) and the number of cough bouts (p=0.04) compared with placebo. Lesogaberan was well tolerated in this study. Conclusions Lesogaberan improved cough hypersensitivity and the number of bouts of coughing, but not coughs per hour. This implies a possible role for peripheral GABAB receptors in refractory chronic cough. Lesogaberan, a peripherally acting GABAB agonist, does not reduce 24-h cough frequency in patients with chronic cough despite significantly reducing capsaicin-induced coughinghttps://bit.ly/3uGyPQL
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23
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ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022; 117:27-56. [PMID: 34807007 PMCID: PMC8754510 DOI: 10.14309/ajg.0000000000001538] [Citation(s) in RCA: 247] [Impact Index Per Article: 123.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/30/2021] [Indexed: 01/30/2023]
Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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25
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He J, Wang C, Li W. Laryngopharyngeal Reflux in Obstructive Sleep Apnea-Hypopnea Syndrome: An Updated Meta-Analysis. Nat Sci Sleep 2022; 14:2189-2201. [PMID: 36545474 PMCID: PMC9762266 DOI: 10.2147/nss.s390272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
Laryngopharyngeal reflux (LPR) is a common disorder in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). This meta-analysis was carried out to evaluate the LPR prevalence in individuals with OSAHS and to analyze the correlation of LPR positivity with the clinical features of patients with OSAHS. A detailed review of the English and Chinese literature on the occurrence of LPR in patients with OSAHS was performed by employing online search tools such as PubMed, EMBASE, Web of Science, VIP, CNKI, WanFang, etc. Two researchers analyzed the studies for quality according to the STROBE standard checklist. The acquired data were analyzed using Stata 11.0 and R 3.6.1 software. The effect size was estimated and calculated using weighted mean difference (WMD) and correlation coefficients. Moreover, a combined analysis was performed by employing either a random- or fixed-effects model. Ultimately, 27 studies met our inclusion criteria. Our study revealed that the LPR prevalence in OSAHS patients was 49%. We carried out subgroup analyses as per OSAHS severity, ethnicity, and body mass index (BMI). The results suggested that the probability of LPR in European and American patients with OSAHS was higher, and the prevalence of LPR was higher in obese individuals and patients with severe OSAHS. Moreover, apnea-hypopnea index (AHI) and BMI were higher in LPR-positive OSAHS patients than in LPR-negative OSAHS patients, but no significant variation in age was observed in the two groups. Moreover, the reflux symptom index (RSI) scores and the reflux finding score (RFS) exhibited a positive correlation with AHI. The current literature shows a higher incidence of LPR in individuals with OSAHS (49%). The severity of AHI in individuals with OSAHS is associated with the presence of LPR. Patients with OSAHS accompanied by LPR showed higher BMI and AHI as compared to those patients with LPR-negative OSAHS.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People's Republic of China
| | - Chunmao Wang
- Clinical Medical College of Chengdu Medical College, Chengdu, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People's Republic of China
| | - Wancheng Li
- Clinical Medical College of Chengdu Medical College, Chengdu, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People's Republic of China
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26
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Heartburn as a Marker of the Success of Acid Suppression Therapy in Chronic Cough. Lung 2021; 199:597-602. [PMID: 34797407 PMCID: PMC8626359 DOI: 10.1007/s00408-021-00496-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/30/2021] [Indexed: 11/05/2022]
Abstract
Purpose Gastro-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. Methods A 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. Results Of 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). Conclusion In 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.
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27
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Benbadis S, Ledford R, Sawchuk T, Dworetzky B. A Broader Perspective: Functional Symptoms Beyond Neurology. Epilepsy Behav Rep 2021; 18:100506. [PMID: 35198949 PMCID: PMC8850744 DOI: 10.1016/j.ebr.2021.100506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022] Open
Abstract
Functional (psychogenic) symptoms exist in all specialties. They are by definition not under voluntary control, unlike factitious disorders and malingering. The diagnostic approach to functional symptoms varies among specialties.
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Affiliation(s)
- S. Benbadis
- University of South Florida, United States
- Corresponding author.
| | - R. Ledford
- University of South Florida, United States
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28
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The Results From Up-Front Esophageal Testing Predict Proton Pump Inhibitor Response in Patients With Chronic Cough. Am J Gastroenterol 2021; 116:2199-2206. [PMID: 34287222 DOI: 10.14309/ajg.0000000000001389] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/24/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The clinical management of chronic cough patients is challenging, and their response to proton pump inhibitors (PPIs) is considered as unsatisfactory. Few data concerning the association between impedance-pH variables and PPI response in these patients are available. Mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave (PSPW) index increase the diagnostic yield of impedance-pH in gastroesophageal reflux disease. METHODS Demographic, clinical, and endoscopy findings; impedance-pH; and high-resolution manometry tracings from consecutive patients assessed for cough were evaluated. Univariable and multivariable regression models were generated to evaluate the association between impedance-pH and high-resolution manometry findings, endoscopic and clinical characteristics, and PPI response. RESULTS A total of 178 patients were included. Eighty-four of 178 cough patients (47.2%) displayed grade C-D erosive esophagitis or were characterized by a pathological acid exposure time (AET) and/or positive symptom association probability/symptom index. When also considering MNBI and PSPW, 135 of 178 patients (75.8%) were characterized by the evidence of reflux disease (P < 0.001). Eighty patients (44.9%) had cough responding to PPIs, whereas 98 (55.1%) were nonresponders (P = 0.071). At the receiver operating characteristic analysis, both PSPW index and MNBI were associated to PPI responsiveness. MNBI and PSPW index showed higher sensitivity in predicting PPI response compared with AET and symptom association probability/symptom index. The area under the curves of MNBI and PSPW index were significantly higher than that of AET (P < 0.01 for both comparisons). When patients were stratified according to AET and excluding those with erosive esophagitis, pathological MNBI or PSPW index, hiatal hernia, and hypomotility features were associated to PPI response in all groups. DISCUSSION Our results demonstrate the usefulness of an up-front esophageal testing in discriminating reflux-related cough patients and predicting PPI response.
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Lee JH, Kang SY, Yoo Y, An J, Park SY, Lee JH, Lee SE, Kim MH, Kanemitsu Y, Chang YS, Song WJ. Epidemiology of adult chronic cough: disease burden, regional issues, and recent findings. Asia Pac Allergy 2021; 11:e38. [PMID: 34786368 PMCID: PMC8563099 DOI: 10.5415/apallergy.2021.11.e38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic cough is a common medical condition that has a significant impact on patients' quality of life. Although it was previously considered a symptom of other disorders, it is now regarded as a pathologic state that is characterized by a deviation from the intrinsic protective functions of the cough reflex, especially in adults. There are several factors that may underlie the cough reflex hypersensitivity and its persistence, such as age, sex, comorbidities, viral infection, exposure to irritants or environmental pollutants, and their interactions may determine the epidemiology of chronic cough in different countries. With a deeper understanding of disease pathophysiology and advanced research methodology, there are more attempts to investigate cough epidemiology using a large cohort of healthcare population data. This is a narrative overview of recent findings on the disease burden, risk factors, Asia-Pacific issues, and longitudinal outcomes in adults with chronic cough. This paper also discusses the approaches utilizing routinely collected data in cough research.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Youngsang Yoo
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Jin An
- Department of Allergy, Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rameau A, Andreadis K, Bayoumi A, Kaufman M, Belafsky P. Side Effects of Proton Pump Inhibitors: What are Patients’ Concerns? J Voice 2021; 35:809.e15-809.e20. [DOI: 10.1016/j.jvoice.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 02/06/2023]
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Sykes DL, Morice AH. The Cough Reflex: The Janus of Respiratory Medicine. Front Physiol 2021; 12:684080. [PMID: 34267675 PMCID: PMC8277195 DOI: 10.3389/fphys.2021.684080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 01/11/2023] Open
Abstract
In clinical practice, we commonly face adversity when encountering dysfunction of the cough reflex. Similar to ancient Roman deity Janus, it often presents with one of two opposing "faces". Continual aberrant activation of the cough reflex, also known as chronic cough, can cause great detriment to quality of life and many of these patients are left misdiagnosed and undertreated. In contrast, loss of normal functioning of the cough reflex is the cause of a significant proportion of mortality in the elderly, primarily through the development of aspiration pneumonia. In this review we discuss both hyper- and hypo-activation of the cough reflex and how airway reflux and chronic aspiration may be involved in the aetiology and sequalae of both disease states. We detail the physiological and pharmacological mechanisms involved in cough, and how the recent development of P2X3 receptor antagonists may lead to the first pharmaceutical agent licensed for chronic cough. The treatment and prevention of loss of the cough reflex, which has been largely neglected, is also discussed as novel low-cost interventions could help prevent a number of hospital and domiciliary deaths from both acute and chronic aspiration.
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Affiliation(s)
- Dominic L Sykes
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Alyn H Morice
- Hull York Medical School, University of York, York, United Kingdom
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Kardos P, Blaiss M, Dicpinigaitis P. Addressing unmet needs for diagnosis and management of chronic cough in the primary care setting. Postgrad Med 2021; 133:481-488. [PMID: 33830846 DOI: 10.1080/00325481.2021.1914944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic cough (i.e. cough lasting >8 weeks) has a global prevalence of approximately 10% and is associated with substantial patient burden, including social, psychological, and physical impairments. This burden can be long-lasting, with some patients experiencing cough for many years. Although chronic cough is often a symptom of respiratory diseases (e.g. interstitial lung disease, chronic obstructive pulmonary disease) or is associated with comorbid conditions (e.g. asthma, gastroesophageal reflux disease) and may resolve after targeted treatment of these conditions, some patients continue to cough despite optimal treatment of associated conditions (refractory chronic cough (RCC)) or have no identifiable conditions presumed to be contributing to the cough (unexplained chronic cough (UCC)). As both RCC and UCC are diagnoses of exclusion, it is critical to perform a thorough initial patient assessment with adherence to diagnostic guidelines to accurately identify RCC and UCC and provide appropriate treatment. Primary care physicians may be in an important position to provide the initial diagnostic workup of patients with chronic cough as well as identify when referral to specialists (e.g. pulmonologists, allergists, otolaryngologists) is appropriate. In this narrative review, current diagnosis and management guidelines for chronic cough are summarized and recommendations for diagnostic workup in a primary care setting are provided. Increased appreciation of chronic cough as a distinct condition, rather than as only a symptom of other diseases, may help overcome current challenges in diagnosing and managing chronic cough and reduce patient burden.
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Affiliation(s)
- Peter Kardos
- Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt, Germany
| | - Michael Blaiss
- Medical College of Georgia at Augusta University, Augusta, GA, US
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, US
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33
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Abstract
Since the recognition of angiotensin-converting enzyme inhibitors (ACEIs)-induced cough, drug has been considered as a potential cause of chronic cough. This review presents recent knowledge on drug-induced coughs in patients with chronic cough. The focus is placed on ACEIs, for which there are a multitude of studies documenting their associations with cough. Additional drugs are discussed for which there are reports of cough as a side effect of treatment, and the potential mechanisms of these effects are discussed.
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Affiliation(s)
- J-S Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul,
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34
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Affiliation(s)
- Ruchong Chen
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kefang Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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35
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McDonnell MJ, Hunt EB, Ward C, Pearson JP, O'Toole D, Laffey JG, Murphy DM, Rutherford RM. Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review. ERJ Open Res 2020; 6:00190-2019. [PMID: 33693049 PMCID: PMC7927787 DOI: 10.1183/23120541.00190-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies. Gastro-oesophageal reflux disease is prevalent among patients with chronic respiratory disease. A number of medical and surgical treatment options are available for GORD. This review examines available evidence in the setting of chronic lung disease.https://bit.ly/34TcMJS
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Affiliation(s)
- Melissa J McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.,Lung Biology Group, National University of Ireland, Galway, Ireland.,Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Eoin B Hunt
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
| | - Chris Ward
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Jeffrey P Pearson
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Daniel O'Toole
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - Desmond M Murphy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
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Abstract
Chronic cough is a common condition, and generally affects about 3% of Korean adults with a significant influence on quality of life (QoL). Despite continued clinical and academic efforts, there are unmet needs for chronic cough prevention and management in Korea. Epidemiologically, there are two major challenges: an aging population and air pollution. Korea is one of the most rapidly aging countries, and the relative proportion of elderly to younger people is expected to double within the next two decades. Air pollution is a major concern, but there is very limited evidence on the effects of air pollutant on cough in Korean patients. Clinically, upper and lower airway diseases, such as rhinitis/rhinosinusitis and cough variant asthma/eosinophilic bronchitis, are reported to account for about 75% of chronic cough in Korean adults, which formed the basis in formulating clinical practice guidelines. However, further studies are warranted to resolve clinical uncertainty, particularly for the evaluation and treatment of upper airway conditions in chronic cough. The prevalence of gastroesophageal reflux disease (GERD) is increasing, thus its relevance to cough among Koreans may warrant re-evaluation. Infection-associated chronic cough, such as tuberculosis, is another continuing concern. The proportion of chronic refractory or unexplained cough is assumed to be 10–20% among patients visiting referral clinics for chronic cough. This review presents our perspectives on current epidemiological and clinical issues of chronic cough in Korea, and addresses major knowledge gaps and future research priorities.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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37
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Zhang M, Zhu Y, Dong R, Qiu Z. Gabapentin versus baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough. J Thorac Dis 2020; 12:5243-5250. [PMID: 33145100 PMCID: PMC7578446 DOI: 10.21037/jtd-2020-icc-002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Refractory gastroesophageal reflux-induced chronic cough (GERC) is a special type of gastroesophageal reflux disease (GERD) with predominant cough resistant to pragmatic standard anti-reflux therapy including antisecretory agents alone or in combination with promotility agents but with a favorable response to intensified anti-reflux treatment. The condition is not rare and is difficult to treat. Neuromodulators such as baclofen and gabapentin are considered potential therapeutic options for refractory GERC. Limited data indicate that gabapentin and baclofen could attenuate the cough symptom in patients with refractory GERC by blockade of gastroesophageal reflux or by direct antitussive effects. However, no study has compared the efficacy of these two drugs in treatment of refractory GERC. In an open-labeled randomized clinical study, we demonstrated that, as add-on therapy, gabapentin and baclofen had a similar prevalence of therapeutic success for suspected refractory GERC but gabapentin may be more preferable because of its fewer central side effects. The efficacy of baclofen and gabapentin was suboptimal, so further studies are needed to select the patients with refractory GERC suitable for precise treatment using these two neuromodulators.
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Affiliation(s)
- Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ran Dong
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Mazzone SB, McGarvey L. Mechanisms and Rationale for Targeted Therapies in Refractory and Unexplained Chronic Cough. Clin Pharmacol Ther 2020; 109:619-636. [PMID: 32748976 PMCID: PMC7983941 DOI: 10.1002/cpt.2003] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022]
Abstract
Chronic cough, defined as a cough lasting > 8 weeks, is a common medical condition that exerts a substantial physical, mental, and social burden on patients. A subset of patients with chronic cough are troubled with a cough that persists despite optimal treatment of presumed associated common and uncommon conditions (refractory chronic cough; RCC) or in which no diagnosable cause for cough can be identified despite extensive assessment (unexplained chronic cough; UCC). Many of these patients exhibit clinical features of cough hypersensitivity, including laryngeal paresthesia, hypertussia, and allotussia. Over-the-counter cough remedies are ineffective and can lead to intolerable side effects when used for RCC/UCC, and the lack of approved treatments indicated for these conditions reflects a major unmet need. An increased understanding of the anatomy and neurophysiology of protective and pathologic cough has fostered a robust clinical development pipeline of several targeted therapies for RCC/UCC. This manuscript reviews the mechanisms presumed to underly RCC/UCC together with the rationale and clinical evidence for several targeted therapies currently under clinical investigation, including transient receptor potential channel antagonists, P2X3-receptor antagonists, voltage-gated sodium channel blockers, neuromodulators, and neurokinin-1-receptor antagonists. Finally, we provide an overview of targets that have been investigated in preclinical models of cough and other airway diseases that may hold future promise for clinical studies in RCC/UCC. Development of targeted therapies with different sites of action may foster a precision medicine approach to treat this heterogeneous, underserved patient population.
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Affiliation(s)
- Stuart B Mazzone
- Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK
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Cho JH, Shin CM, Yoon H, Park YS, Kim N, Lee DH. Efficacy of a high-dose proton pump inhibitor in patients with gastroesophageal reflux disease: a single center, randomized, open-label trial. BMC Gastroenterol 2020; 20:275. [PMID: 32811427 PMCID: PMC7433117 DOI: 10.1186/s12876-020-01410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background The extraesophageal manifestations of gastroesophageal reflux disease (GERD) are more difficult to manage than the typical symptoms. The efficacy of high-dose and standard-dose proton pump inhibitors against these atypical symptoms is not yet established. Methods In this single center, randomized, open-label study, patients with GERD received rabeprazole for 8 weeks, either 20 mg once daily (standard-dose group) or 20 mg twice daily (high-dose group). Patients were assessed before treatment and at weeks 4 and 8 with a 5-graded scale questionnaire consisting of 2 typical symptoms (heartburn and acid regurgitation) and 8 atypical symptoms (chest pain, cough, globus, wheezing, laryngopharyngitis, hoarseness, belching, and dysphagia). Sufficient improvement of reflux symptoms was defined as ≥50% reduction from the initial questionnaire score. Results Final analyses included 35 patients in the standard-dose group and 38 patients in the high-dose group. The rate of sufficient improvement for typical symptoms was significantly higher in the high-dose group than in the standard-dose group (100.0% vs. 84.0%, P = 0.040). For atypical symptoms, the rate of sufficient improvement tended to be higher in the high-dose group than in the standard-dose group (82.4% vs. 63.0%, P = 0.087). Scores of typical and some atypical symptoms (cough and globus) improved after treatment, with significant inter-group differences in time-course changes. Conclusions High-dose rabeprazole is more effective for relieving typical GERD symptoms and some atypical symptoms such as cough and globus than a standard-dose regimen. Trial registration This research was enrolled in a registry of clinical trials run by United States National Library of Medicine at the National Institutes of Health (ClinicalTrials.gov Protocol Registration and Results system ID: NCT04001400). This study was registered on June 26, 2019 - Retrospectively registered.
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Affiliation(s)
- Jae Ho Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
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Song WJ, An J, McGarvey L. Recent progress in the management of chronic cough. Korean J Intern Med 2020; 35:811-822. [PMID: 32422697 PMCID: PMC7373968 DOI: 10.3904/kjim.2020.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic cough is a common clinical condition with significant impact on quality of life and for which effective therapy remains an unmet clinical need. Over the past decade, there has been a major shift in how we approach this problem, driven by better appreciation of the clinical manifestation of chronic cough and an improved understanding of the associated neurobiology. "Cough hypersensitivity syndrome" has been proposed as a new diagnostic term for chronic cough, encompassing different phenotypes of the condition. Accumulating evidence suggests that this new concept is clinically relevant. However, while it is gaining widespread endorsement within the allergy and respiratory community, raising its profile in routine clinical practice is a priority. Thus, the present paper reviews recent progress in our understanding and management of chronic cough, with focus on mechanistic and clinical studies. It also provides detail on knowledge gaps and future research directions.
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Quitadamo P, Giorgio V, Zenzeri L, Baldassarre M, Cresi F, Borrelli O, Salvatore S. Apnea in preterm neonates: what's the role of gastroesophageal reflux? A systematic review. Dig Liver Dis 2020; 52:723-729. [PMID: 32423847 DOI: 10.1016/j.dld.2020.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
A causal relationship between gastro-esophageal reflux (GER) and apnea in preterm infants has been frequently hypothesized and is currently debated. The present study aims at reviewing the currently available scientific evidence, in order to clarify the role of GER on the occurrence of apnea and to help improving the clinical management of apneic preterm neonates. We performed a systematic literature search to identify all the clinical studies on preterm neonates that properly assessed the relationship between apnea and GER. Two-hundred and fifty-two papers, including 32 reviews and meta-analysis, were screened. Out of them, only 7 were included in the final analysis according to the selected criteria. Among them, 3 studies reported an increased frequency of apnea after reflux compared to reflux-free period and 4 denied a significant temporal relation. In conclusion, a minority of apneic events occurs soon after GER episodes. Whether this happens by chance or because of a causal relationship is still impossible to define. Based on the available data, empirical treatment with acid inhibitors is not recommended in neonates with apnea unless a proven temporal relation is shown by simultaneous esophageal pH-impedance and polysomnography or cardiorespiratory monitoring and in the absence of a clear clinical benefit.
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Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy.
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - Letizia Zenzeri
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Mariella Baldassarre
- Department of biomedical science and human oncology- neonatology and Nicu section. University "Aldo Moro", Bari, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
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Katzka DA, Pandolfino JE, Kahrilas PJ. Phenotypes of Gastroesophageal Reflux Disease: Where Rome, Lyon, and Montreal Meet. Clin Gastroenterol Hepatol 2020; 18:767-776. [PMID: 31319183 PMCID: PMC6960363 DOI: 10.1016/j.cgh.2019.07.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
Abstract
Gastroesophageal reflux disease (GERD) is now one of the most common diagnoses made in a gastroenterology practice. From a conventional pathophysiological perspective, GERD is conceptualized as incompetence of the antireflux barrier at the esophagogastric junction; the more severe that incompetence, the worse the disease. However, it is increasingly clear that many presentations of GERD represent distinct phenotypes with unique predisposing cofactors and pathophysiology outside of this paradigm. Three major consensus initiatives have grappled with this dilemma (the Montreal Consensus, The Rome Foundation, and the Lyon Consensus), each from a different perspective. Montreal struggled to define the disease, Rome sought to characterize its functional attributes, while Lyon examined its physiological attributes. Here, we merge the 3 perspectives, developing the concept that what has come to be known as GERD is actually a family of syndromes with a complex matrix of contributing pathophysiology. A corollary to this is that the concept of one size fits all to therapeutics does not apply, and that although escalating treatment with proton pump inhibitors (PPIs) may be pertinent to healing esophagitis, its applicability beyond that is highly questionable. Similarly, failing to recognize the modulating effects of anxiety, hypervigilance, and visceral and central hypersensitivity on symptom severity has greatly oversimplified the problem. That oversimplification has led to excessive use of PPIs for everything captured under the GERD umbrella and shown a broad spectrum of syndromes less amenable to PPI therapy in any dose. It is with this in mind that we delineate this precision medicine concept of GERD.
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Affiliation(s)
- David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John E Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter J Kahrilas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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43
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Ribolsi M, Guarino MPL, Tullio A, Cicala M. Post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance predict PPI response in GERD patients with extra esophageal symptoms. Dig Liver Dis 2020; 52:173-177. [PMID: 31623954 DOI: 10.1016/j.dld.2019.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index are able to increase the diagnostic yield of impedance-pH and are associated to proton pump inhibitor (PPI) response. Few data concerning these variables in patients with extra-esophageal symptoms (EES) are available. AIMS To evaluate, in EES patients, the role of the conventional and new impedance-pH variables in diagnosing GERD and the predictive value of impedance-pH variables for PPI response. METHODS Consecutive patients presenting suspected GERD-related EES underwent impedance-pH. Patients treated in the last six months with double dose PPI therapy were enrolled. The presence of concomitant typical symptoms was assessed. RESULTS 239 EES patients were studied; 102 responders and 137 non-responders. Eighty-one (34%) were affected by non-erosive reflux disease (NERD), 61 (26%) presented reflux hypersensitivity (RH) and 97 (40%) were non-GERD. In NERD and RH groups, a significantly higher proportion of patients with pathological PSPW index or MNBI values compared to non-GERD group was observed. 24 (25%) non-GERD patients presented a pathological PSPW index and/or MNBI. Pathological PSPW index, MNBI and presence of typical symptoms were associated to PPI response. CONCLUSIONS MNBI and PSPW index measurement increases the diagnostic yield of impedance-pH; abnormal values are associated with a satisfactory response to acid-suppressive therapy in EES patients.
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Affiliation(s)
- Mentore Ribolsi
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy.
| | | | - Alessandro Tullio
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy
| | - Michele Cicala
- Department of digestive diseases, Campus Bio Medico University, Rome, Italy
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44
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Song WJ, Chung KF. Exploring the clinical relevance of cough hypersensitivity syndrome. Expert Rev Respir Med 2020; 14:275-284. [PMID: 31914340 DOI: 10.1080/17476348.2020.1713102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Knowledge of the pathophysiology of cough has continued to advance over recent decades. Establishing anatomic-diagnostic protocols, based on the anatomy and distribution of vagus nerve pathways regulating the cough reflex, was the first breakthrough in modern clinical medicine for chronic cough. The unmet clinical need has prompted revised thinking regarding the pathophysiology of and the clinical approach to chronic cough.Areas covered: The paradigm of cough hypersensitivity syndrome (CHS) has been recently proposed, wherein aberrant neuro-pathophysiology is a common etiology. This review covers major findings on chronic cough and cough hypersensitivity, particularly focused on recently-published studies and explores the clinical relevance and applicability of CHS based on current knowledge and discuss knowledge gaps and future research directions.Expert opinion: This paradigm has provided new opportunities in managing chronic cough and evidence is accumulating to support the validity of CHS. It also warrants the re-appraisal of existing clinical evidence and investigation of how to refine our clinical strategy. While CHS highlights the importance of clinical thinking from the viewpoint of cough, the value of anatomic-diagnostic protocols should remain. Moreover, given the considerable heterogeneity in clinical presentation, cough-associated disease conditions, and treatment responses across different patients, precise molecular endotyping remains key to making further to advancing clinical practice .
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield NHS Trust, London, UK
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Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, Hilton Boon M, Kantar A, Lai K, McGarvey L, Rigau D, Satia I, Smith J, Song WJ, Tonia T, van den Berg JWK, van Manen MJG, Zacharasiewicz A. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55:1901136. [PMID: 31515408 PMCID: PMC6942543 DOI: 10.1183/13993003.01136-2019] [Citation(s) in RCA: 366] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 01/07/2023]
Abstract
These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
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Affiliation(s)
- Alyn H Morice
- Respiratory Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Bieksiene
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Dept of Respiratory Medicine, King's College Hospital, London, UK
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Christian Domingo Ribas
- Pulmonary Service, Corporació Sanitària Parc Taulí (Sabadell), Dept of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Michele Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ahmad Kantar
- Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Kefang Lai
- Dept of Clinical Research, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Representing the Chinese Thoracic Society
| | - Lorcan McGarvey
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Imran Satia
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester, UK
| | - Jacky Smith
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Woo-Jung Song
- Airway Sensation and Cough Research Laboratory, Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Representing the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI)
| | | | | | - Mirjam J G van Manen
- Dept of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angela Zacharasiewicz
- Dept of Pediatrics, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
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Song WJ, Millqvist E, Morice AH. New ERS cough guidelines: A clinical framework for refining the patient management strategy. Asia Pac Allergy 2019; 9:e36. [PMID: 31720247 PMCID: PMC6826112 DOI: 10.5415/apallergy.2019.9.e36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alyn H Morice
- Respiratory Research Group, University of Hull, Hull York Medical School, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom
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Abstract
Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.
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Affiliation(s)
- A Mathur
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - P S K Liu-Shiu-Cheong
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - G P Currie
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
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Ghisa M, Della Coletta M, Barbuscio I, Marabotto E, Barberio B, Frazzoni M, De Bortoli N, Zentilin P, Tolone S, Ottonello A, Lorenzon G, Savarino V, Savarino E. Updates in the field of non-esophageal gastroesophageal reflux disorder. Expert Rev Gastroenterol Hepatol 2019; 13:827-838. [PMID: 31322443 DOI: 10.1080/17474124.2019.1645593] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions in Western Countries, normally presenting with heartburn and regurgitation. Extra-esophageal (EE) GERD manifestations, such as asthma, laryngitis, chronic cough and dental erosion, represent the most challenging aspects from diagnostic and therapeutic points of view because of their multifactorial pathogenesis and low response to proton pump inhibitors (PPIs). In fact, in the case of EE, other causes must by preventively excluded, but instrumental methods, such as upper gastrointestinal endoscopy and laryngoscopy, have low specificity and sensitivity as diagnostic tools. In the absence of alarm signs and symptoms, empirical therapy with a double-dose of PPIs is recommended as a first diagnostic approach. Subsequently, impedance-pH monitoring could help to define whether the symptoms are GERD-related. Areas covered: This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed.
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Affiliation(s)
- Matteo Ghisa
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Marco Della Coletta
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Ilenia Barbuscio
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Elisa Marabotto
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Brigida Barberio
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | | | - Nicola De Bortoli
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Pisa , Italy
| | - Patrizia Zentilin
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli , Caserta , Italy
| | - Andrea Ottonello
- Department of Surgical Science and Integrated Diagnostics, University of Genoa , Genoa , Italy
| | - Greta Lorenzon
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Vincenzo Savarino
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Edoardo Savarino
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
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Chen D, Wang Z, Hu Z, Liang Y, Xiao F, Wu J. Typical symptoms and not positive reflux-cough correlation predict cure of gastroesophageal reflux disease related chronic cough after laparoscopic fundoplication: a retrospective study. BMC Gastroenterol 2019; 19:108. [PMID: 31242859 PMCID: PMC6595575 DOI: 10.1186/s12876-019-1027-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background The effect of laparoscopic fundoplication on reflux-related chronic cough is unpredictable, the aim of the study is to investigate the predictive effect of positive reflux-cough correlation on the resolution of reflux-related chronic cough after anti-reflux surgery. Methods A 5 years retrospective review was performed. Logistic regression analysis was used to determine the independent predictors on the cure of chronic cough. Results Seventy-nine patients were included in this study, among which chronic cough was cured in 47 (59.5%) and significantly improved in 10 (12.7%) patients. Present of typical symptoms (odds ratio = 6.435,95% confidence interval [CI] = 1.427–29.032, p = 0.015) and number of Reflux episodes (impedance) ≥73 (odds ratio = 0.306, 95% confidence interval [CI] = 0.107–0.874, p = 0.027) were significantly associated with the cure of chronic cough. Conclusions laparoscopic fundoplicaiton is effective for the management of reflux-related chronic cough, particularly with the present of typical symptoms. Trial registration (Trial registration number: ChiCTR1800016444; Trial registration date: June 01, 2018)
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Affiliation(s)
- Dong Chen
- Department of vascular surgery, xuanwu hospital, Capital medical unversity, Beijing, China
| | - Zhonggao Wang
- Department of vascular surgery, xuanwu hospital, Capital medical unversity, Beijing, China. .,Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China.
| | - Zhiwei Hu
- Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China
| | - Yan Liang
- Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China
| | - Fei Xiao
- Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China
| | - Jimin Wu
- Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China
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