Summary
Chronic cough is multifactorial in origin, may affect quality of life adversely, and
often poses a diagnostic challenge for physicians. Laryngopharyngeal reflux (LPR)
is one common contributing factor for chronic cough, but the mechanism by which reflux
causes cough remains unclear. Research investigating the relationship between chronic
cough and LPR has focused largely on reflux from the perspective of gastroenterology,
rather than otolaryngology.
Objective
The purpose of our study was to investigate the relationship between chronic cough
and LPR by using the objective results of 24-hour pH impedance studies.
Methods
We conducted a retrospective chart review of all patients who presented to the voice
center of the senior author (RTS) with a chief complaint of chronic cough and no previous
diagnosis of reflux. Patient demographics, past medical history, laboratory data,
and exam findings during the initial visit from 2015 to 2020 and at follow-up were
analyzed.
Results
We identified 28 patients who presented with a chief complaint of chronic cough and
who had not been diagnosed with or treated for reflux previously. Twenty-three had
additional risk factors for chronic cough (asthma, chronic sinusitis, and bronchial
schwannoma). All 28 had findings consistent with LPR upon exam. Treatment with reflux
medications and lifestyle modification decreased the reflux finding score significantly
from 11.39 to 9.21 (P= 0.005). Of all, 60.7% of patients reported subjective improvement in cough symptoms.
The cough had improved in 50.0% and had resolved completely in 10.7%. Patients with
VF paresis were less likely to report improvement in their cough. Further workup was
performed for the 11 patients who had cough that did not resolve completely after
reflux treatment. Detectable levels of antimycoplasma antibodies were found in nine
patients, and antipertussis antibodies were found in two patients. Six patients followed
up after a course of clarithromycin, three of whom had experienced improvement in
their cough.
Conclusions
Our findings suggest that LPR may be a prevalent contributing or etiologic factor
for chronic cough. The expected improvement after initiating reflux treatment is 60%
at 3 months. Cough resolved completely in 10% of patients at 4 months. Nonresponders
may have other contributing causes of cough, including esophageal dysmotility, mycoplasma,
pertussis, and other contributors. Further studies are needed to confirm or refute
these findings.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Otolaryngology aspects of chronic cough.J Allergy Clin Immunol Practice. 2019; 7: 1753
- Cough, a vital reflex. Mechanisms, determinants and measurements.Acta Biomed. 2018; 89: 477-480
- Classification of cough as a symptom in adults and management algorithms.CHEST J. 2018; 153: 196-201
- Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- The REDCap consortium: building an international community of software platform partners.J Biomed Inform. 2019; 95103208
- Validity of reflux symptom index (RSI).J Voice. 2002; 16: 274-277
- The validity and reliability of the reflux finding score (RFS).Laryngoscope. 2001; 111: 1313-1317
- Development and validation of the cough severity index for chronic cough related to the upper airway.Laryngoscope. 2013; 123: 1931-1936
- Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole.Eur Resp J. 2000; 16: 633-638
- Clinical outcomes of gastroesophageal reflux disease-related chronic cough following antireflux fundoplication.Esophagus. 2020; 17: 92-98
- Incidence of seropositivity to bordetella pertussis and mycoplasma pneumoniae infection in patients with chronic laryngotracheitis.Laryngoscope. 2009; 119: 1839-1843
- Mycoplasma pneumoniae vaccine protective efficacy and adverse reactions—Systematic review and meta-analysis.Vaccine. 2009; 27: 2437-2446
Lee AD, Cassiday PK, Pawloski LC, et al. Clinical evaluation and validation of laboratory methods for the diagnosis of Bordetella pertussis infection: culture, polymerase chain reaction (PCR) and anti-pertussis toxin IgG serology. PLoS One 13:e0195979.
- Immune responses in adults to revaccination with a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine 10 years after a previous dose.Vaccine. 2012; 30: 974-982
- Humoral immunity 5 years after booster immunization with an adolescent and adult formulation combined tetanus, diphtheria, and 5-component acellular pertussis vaccine.Vaccine. 2007; 25: 8172-8179
- Airway protective mechanisms.Lung. 2014; 192: 27-31
- Vocal fold paresis and paralysis.Otolaryngol Clin N Am. 2007; 40: 1109-1131
- Neurogenic cough.Laryngoscope. 2015; 125: 1675-1681
- The powerful placebo effect in cough: relevance to treatment and clinical trials.Lung. 2020; 198: 13-21
Article info
Publication history
Published online: November 28, 2020
Accepted:
November 16,
2020
Identification
Copyright
© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
