Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report

Peter J. Kahrilas, Kenneth W. Altman, Anne B. Chang, Stephen K. Field, Susan M. Harding, Andrew P. Lane, Kaiser Lim, Lorcan McGarvey, Jaclyn Smith, Richard S. Irwin, Todd M. Adams, Kenneth W. Altman, Elie Azoulay, Alan F. Barker, Fiona Blackhall, Donald C. Bolser, Louis Philippe Boulet, Christopher Brightling, Priscilla Callahan-Lyon, Brendan J. CanningTerrie Cowley, Satoru Ebihara, Ali A. El Solh, Patricio Escalante, Stephen K. Field, Anthony Feinstein, Dina Fisher, Cynthia T. French, Peter Gibson, Philip Gold, Michael K. Gould, Cameron Grant, Susan M. Harding, Anthony Harnden, Adam T. Hill, Richard S. Irwin, Peter J. Kahrilas, Karina A. Keogh, Kefang Lai, Andrew P. Lane, Kaiser Lim, Mark A. Malesker, Stuart Mazzone, Lorcan McGarvey, M. Hassan Murad, Huong Q. Nguyen, Peter Newcombe, John Oppenheimer, Mark Rosen, Bruce Rubin, Jay H. Ryu, Jaclyn Smith, Susan M. Tarlo, Anne E. Vertigan, Gang Wang, Miles Weinberger, Kelly Weir

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Background We updated the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome. Methods Two population, intervention, comparison, outcome (PICO) questions were addressed by systematic review: (1) Can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough? and (2) Are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux? Results We found no high-quality studies pertinent to either question. From available randomized controlled trials (RCTs) addressing question #1, we concluded that (1) there was a strong placebo effect for cough improvement; (2) studies including diet modification and weight loss had better cough outcomes; (3) although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, proton pump inhibitors (PPIs) demonstrated no benefit when used in isolation; and (4) because of potential carryover effect, crossover studies using PPIs should be avoided. For question #2, we concluded from the available observational trials that (1) an algorithmic approach to management resolved chronic cough in 82% to 100% of instances; (2) cough variant asthma and upper airway cough syndrome (UACS) (previously referred to as postnasal drip syndrome) from rhinosinus conditions were the most commonly reported causes; and (3) the reported prevalence of reflux-cough syndrome varied widely. Conclusions The panelists (1) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough, including symptomatic reflux; (2) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, PPIs demonstrated no benefit when used in isolation; and (3) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing.

Original languageEnglish (US)
Pages (from-to)1341-1360
Number of pages20
JournalChest
Volume150
Issue number6
DOIs
StatePublished - Dec 1 2016

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Kahrilas, P. J., Altman, K. W., Chang, A. B., Field, S. K., Harding, S. M., Lane, A. P., Lim, K., McGarvey, L., Smith, J., Irwin, R. S., Adams, T. M., Altman, K. W., Azoulay, E., Barker, A. F., Blackhall, F., Bolser, D. C., Boulet, L. P., Brightling, C., Callahan-Lyon, P., ... Weir, K. (2016). Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report. Chest, 150(6), 1341-1360. https://doi.org/10.1016/j.chest.2016.08.1458