Extrathoracic airway dysfunction in cough associated with gastroesophageal reflux

Rolla, Giovanni; Colagrande, Paola; Magnano, Mauro; Debernardi, Valeria; Dutto, Luca; Delpiano, Luca; Cassolino, Paola; Bucca, Caterina

doi:10.1016/s0091-6749(98)70087-9

Cited by 27 publications

(19 citation statements)

References 35 publications

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“…They also demonstrated both EAHR and enhanced cough sensitivity to inhaled histamine in chronic cough induced by GER (13) and ACEI (14). The results of our study further support these findings.…”

Section: Discussionsupporting

confidence: 87%

“…Recently, extrathoracic airway hyperresponsiveness (EAHR) during histamine inhalation was observed in the patients with asthma-like symptoms (12), GER (13), and ACEI-induced cough (14). We hypothesized that sensory hypersensitivity of extrathoracic airway characterized by increased cough sensitivity and EAHR might induce chronic cough especially in the subjects not to have any definite clues suggesting abnormalities of lower airway and in the patients Enhanced cough response has been frequently observed in chronic cough.…”

Section: Introductionmentioning

confidence: 99%

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Cough Sensitivity and Extrathoracic Airway Responsiveness to Inhaled Capsaicin in Chronic Cough Patients

et al. 2002

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Enhanced cough response has been frequently observed in chronic cough. Recently, extrathoracic airway constriction to inhaled histamine was demonstrated in some chronic cough patients. However, relation between extrathoracic airway hyperresponsiveness (EAHR) and cough sensitivity determined by capsaicin inhalation is unclear in each etiological entity of chronic cough. Seventy-seven patients, with dry cough persisting for 3 or more weeks, normal spirometry and chest radiography, and 15 controls, underwent methacholine bronchial provocation test and capsaicin cough provocation test. Elicited cough number and flow-volume curve was examined after inhalation of capsaicin to evaluate cough sensitivity and EAHR. Thirty-three patients, with postnasal drip, showed normal extrathoracic airway responsiveness, and 27 of them showed normal cough sensitivity to capsaicin. Cough sensitivity was enhanced in 14 patients with cough variant asthma (CVA) who showed bronchial hyperresponsiveness; EAHR to inhaled capsaicin was present in 12 of them. The remaining 30 patients were tentatively diagnosed as idiopathic chronic cough (ICC). Eleven ICC patients showed enhanced cough sensitivity and EAHR to inhaled capsaicin while 19 patients showed normal values. These results indicate that cough sensitivity is closely related with extrathoracic airway responsiveness during capsaicin provocation in some chronic cough patients. EAHR and enhanced cough sensitivity to inhaled capsaicin may be a part of mechanism developing chronic cough.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Cough Sensitivity and Extrathoracic Airway Responsiveness to Inhaled Capsaicin in Chronic Cough Patients

et al. 2002

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“…This is in accordance with several previously published studies [1±7, 10, 14±19] in which GOR-related chronic cough was relieved with medical antireflux therapy. Unfortunately most of these 10,14,15] or they have been retrospective [16,17]. There is also evidence that operative treatment of GOR will improve chronic cough [27,28].…”

Section: Discussionmentioning

confidence: 99%

Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole

Kiljander¹,

Salomaa²,

Hietanen³

et al. 2000

Eur Respir J

137

105

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Gastro-oesophageal reflux (GOR) is an important cause of chronic cough. There has been a lack of placebo-controlled trials treating GOR related chronic cough with antireflux therapy. The aim of this study was to determine the efficacy of omeprazole on GOR related chronic cough.After excluding other common causes of cough, oesophageal pH monitoring was performed on 48 patients with chronic cough. Twenty-nine patients found to have GOR were randomized in a double-blind fashion to receive omeprazole 40 mg o.d. or placebo for 8 weeks. After a 2-week washout period, patients were crossed over to the other treatment. Symptoms were recorded daily in a diary.Twenty-one patients completed both treatment periods. Cough (p=0.02) and gastric symptoms (p=0.003) improved significantly during the omeprazole treatment in twelve patients who received placebo during the first and omeprazole during the second 8-week period. In nine patients who received omeprazole during the first 8-week period, amelioration in cough reached statistical significance only after cessation of omeprazole. Gastric symptoms also remained minor during placebo in these nine patients.Omeprazole 40 mg o.d. seems to improve chronic cough in patients with gastrooesophageal reflux and the effect of omeprazole in ameliorating both cough and reflux symptoms continues after treatment ceases. Eur Respir J 2000; 16: 633±638.

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“…One mechanism for this may be microaspiration into the airways. Patients with GORD and chronic cough have higher laryngitis scores and decreased upper esophageal sphincter pressure compared with patients with GORD without cough [31]. A second, perhaps more important, mechanism is of a vagally-mediated reflex elicited in response to distal oesophageal distension or acid-related sensory stimulation.…”

Section: Weakly Acid Reflux: Role In Symptom Perceptionmentioning

confidence: 99%

The refluxate: The impact of its magnitude, composition and distribution

Woodland

Sifrim

2010

Best Practice & Research Clinical Gastroenterology

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Extrathoracic airway dysfunction in cough associated with gastroesophageal reflux

Cited by 27 publications

References 35 publications

Cough Sensitivity and Extrathoracic Airway Responsiveness to Inhaled Capsaicin in Chronic Cough Patients

Cough Sensitivity and Extrathoracic Airway Responsiveness to Inhaled Capsaicin in Chronic Cough Patients

Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole

The refluxate: The impact of its magnitude, composition and distribution

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