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MedLine Citation:
PMID:  22797535     Owner:  NLM     Status:  Publisher    
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.
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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