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CHRONIC COUGH: RELATIONSHIP BETWEEN MICRO-ASPIRATION, GASTROESOPHAGEAL REFLUX AND COUGH FREQUENCY.
MedLine Citation:
PMID:  22797535     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT BACKGROUND: Micro-aspiration is often considered a potential cause of cough. The aim of this study was to investigate the relationship between micro-aspiration, the degree and type of gastro-oesophageal reflux, and the frequency of coughing in patients with chronic cough. METHODS: 100 chronic cough patients [mean age 55.8yrs (±11.0); 65 females] and 32 healthy volunteers [median age 43.5yrs(IQR 30-50.8); 16 females] were recruited. Chronic cough patients performed 24-hour objective cough frequency with simultaneous oesophageal impedance/pH monitoring and measurement of pepsin concentrations in sputum and bronchoalveolar lavage (BAL). 12 healthy volunteers underwent bronchoscopy/ BAL and 20 impedance/pH monitoring. RESULTS: Chronic cough patients had significantly more reflux episodes than healthy volunteers [median 63.5 reflux episodes (IQR 52.5-80.0) versus 59.0 (IQR 41.8-66.0), p=0.03] although the absolute difference was small, and there was no difference in numbers of events extending into the proximal oesophagus [median 17.2% (IQR 8.0-26.0%) versus 20.3% (IQR 5.1-32.1%), (p=0.36)]. BAL pepsin levels were also similar in chronic cough to controls subjects [median 18.2ng/ml (range 0-56.4) versus 9.25ng/ml (0-46.9), p=0.27]. Sputum but not BAL pepsin weakly correlated with the number of proximally occurring reflux events (r=0.33; p=0.045), but was inversely related to cough frequency (r=-0.52, p=0.04). Sputum pepsin was therefore best predicted by combining the opposing influences of cough and proximal reflux (r=0.50, p=0.004). CONCLUSIONS: Proximal gastro-oesophageal reflux and micro-aspiration into the airways have limited roles in provoking chronic cough. Indeed, coughing appears to be protective reducing pepsin concentration in the larger airways of patients with chronic cough.
Authors:
Samantha Decalmer; Rachel Stovold; Lesley A Houghton; Jeff Pearson; Chris Ward; Angela Kelsall; Helen Jones; Kevin McGuinness; Ashley Woodcock; Jaclyn A Smith
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-10
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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