Heartburn as a Marker of the Success of Acid Suppression Therapy in Chronic Cough

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.

Cough hypersensitivity and chronic cough

“…Small RCTs of acid-suppressing therapy (PPIs and H 2 receptor blockers) in patients with chronic cough have been performed but did not report positive results; a pooled analysis of these data suggests that adults with acid reflux on 24 h pH monitoring or symptoms of heartburn are most likely to experience benefit, which is now reflected in clinical guidelines 4 , 141 , 153 . Observational data support this approach, but response rates were low (28%) even in patients with chronic cough who reported heartburn 154 . Treatments for non-acid reflux are limited.…”

Cough hypersensitivity and chronic cough

“…A pooled analysis of these data suggests that adults with acid reflux on 24h pH monitoring or symptoms of heartburn are most likely to experience benefit, which is now reflected in clinical guidelines 4, 144,155 . Observational data supports this approach, but response rates were low (28%) even in chronic cough patients complaining of heartburn 156 . Treatments for non-acid reflux are limited.…”

LUNG Year in Review: 2021

“…Indeed, 2022 promises to be a landmark year in the cough space, as we anticipate the approval of the first-ever drug indicated for the treatment of refractory chronic cough [ 26 , 27 ]. Cough-related articles published in 2021 examined post-COVID-19 cough [ 20 , 22 ], clinical antitussive drug trials [ 28 ], and the importance of the placebo response [ 7 ], relevance of speech-language pathology interventions in chronic cough therapy [ 29 , 30 ], cough monitoring [ 31 ], cough mechanisms, and diagnostic evaluation [ 32 – 39 ].…”