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. Canning & 38 others Anne B. Chang, Terrie 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, Mark A. Malesker, 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

22 Citations (Scopus)

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

Fingerprint

Gastroesophageal Reflux
Cough
Guidelines
Proton Pump Inhibitors
Weight Loss
Life Style
Diet Therapy
Placebo Effect
Practice Management
Practice Guidelines
Cross-Over Studies
Therapeutics
Asthma
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

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

Cite this

Kahrilas, P. J., Altman, K. W., Chang, A. B., Field, S. K., Harding, S. M., Lane, A. 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

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

In: Chest, Vol. 150, No. 6, 01.12.2016, p. 1341-1360.

Research output: Contribution to journalArticle

Kahrilas, PJ, Altman, KW, Chang, AB, Field, SK, Harding, SM, Lane, AP, Lim, K, McGarvey, L, Smith, J, Irwin, RS, Adams, TM, Altman, KW, Azoulay, E, Barker, AF, Blackhall, F, Bolser, DC, Boulet, LP, Brightling, C, Callahan-Lyon, P, Canning, BJ, Chang, AB, Cowley, T, Ebihara, S, El Solh, AA, Escalante, P, Field, SK, Feinstein, A, Fisher, D, French, CT, Gibson, P, Gold, P, Gould, MK, Grant, C, Harding, SM, Harnden, A, Hill, AT, Irwin, RS, Kahrilas, PJ, Keogh, KA, Lai, K, Lane, AP, Malesker, MA, Malesker, MA, Mazzone, S, McGarvey, L, Murad, MH, Nguyen, HQ, Newcombe, P, Oppenheimer, J, Rosen, M, Rubin, B, Ryu, JH, Smith, J, Tarlo, SM, Vertigan, AE, Wang, G, Weinberger, M & Weir, K 2016, 'Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report', Chest, vol. 150, no. 6, pp. 1341-1360. https://doi.org/10.1016/j.chest.2016.08.1458
Kahrilas PJ, Altman KW, Chang AB, Field SK, Harding SM, Lane AP et al. Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report. Chest. 2016 Dec 1;150(6):1341-1360. https://doi.org/10.1016/j.chest.2016.08.1458
Kahrilas, Peter J. ; Altman, Kenneth W. ; Chang, Anne B. ; Field, Stephen K. ; Harding, Susan M. ; Lane, Andrew P. ; Lim, Kaiser ; McGarvey, Lorcan ; Smith, Jaclyn ; Irwin, Richard S. ; Adams, Todd M. ; Altman, Kenneth W. ; Azoulay, Elie ; Barker, Alan F. ; Blackhall, Fiona ; Bolser, Donald C. ; Boulet, Louis Philippe ; Brightling, Christopher ; Callahan-Lyon, Priscilla ; Canning, Brendan J. ; Chang, Anne B. ; Cowley, Terrie ; Ebihara, Satoru ; El Solh, Ali A. ; Escalante, Patricio ; Field, Stephen K. ; Feinstein, Anthony ; Fisher, Dina ; French, Cynthia T. ; Gibson, Peter ; Gold, Philip ; Gould, Michael K. ; Grant, Cameron ; Harding, Susan M. ; Harnden, Anthony ; Hill, Adam T. ; Irwin, Richard S. ; Kahrilas, Peter J. ; Keogh, Karina A. ; Lai, Kefang ; Lane, Andrew P. ; Malesker, Mark A. ; Malesker, Mark A. ; Mazzone, Stuart ; McGarvey, Lorcan ; Murad, M. Hassan ; Nguyen, Huong Q. ; Newcombe, Peter ; Oppenheimer, John ; Rosen, Mark ; Rubin, Bruce ; Ryu, Jay H. ; Smith, Jaclyn ; Tarlo, Susan M. ; Vertigan, Anne E. ; Wang, Gang ; Weinberger, Miles ; Weir, Kelly. / Chronic Cough Due to Gastroesophageal Reflux in Adults : CHEST Guideline and Expert Panel Report. In: Chest. 2016 ; Vol. 150, No. 6. pp. 1341-1360.
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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.",
author = "Kahrilas, {Peter J.} and Altman, {Kenneth W.} and Chang, {Anne B.} and Field, {Stephen K.} and Harding, {Susan M.} and Lane, {Andrew P.} and Kaiser Lim and Lorcan McGarvey and Jaclyn Smith and Irwin, {Richard S.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Elie Azoulay and Barker, {Alan F.} and Fiona Blackhall and Bolser, {Donald C.} and Boulet, {Louis Philippe} and Christopher Brightling and Priscilla Callahan-Lyon and Canning, {Brendan J.} and Chang, {Anne B.} and Terrie Cowley and Satoru Ebihara and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Anthony Feinstein and Dina Fisher and French, {Cynthia T.} and Peter Gibson and Philip Gold and Gould, {Michael K.} and Cameron Grant and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Kahrilas, {Peter J.} and Keogh, {Karina A.} and Kefang Lai and Lane, {Andrew P.} and Malesker, {Mark A.} and Malesker, {Mark A.} and Stuart Mazzone and Lorcan McGarvey and Murad, {M. Hassan} and Nguyen, {Huong Q.} and Peter Newcombe and John Oppenheimer and Mark Rosen and Bruce Rubin and Ryu, {Jay H.} and Jaclyn Smith and Tarlo, {Susan M.} and Vertigan, {Anne E.} and Gang Wang and Miles Weinberger and Kelly Weir",
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TY - JOUR

T1 - Chronic Cough Due to Gastroesophageal Reflux in Adults

T2 - CHEST Guideline and Expert Panel Report

AU - Kahrilas, Peter J.

AU - Altman, Kenneth W.

AU - Chang, Anne B.

AU - Field, Stephen K.

AU - Harding, Susan M.

AU - Lane, Andrew P.

AU - Lim, Kaiser

AU - McGarvey, Lorcan

AU - Smith, Jaclyn

AU - Irwin, Richard S.

AU - Adams, Todd M.

AU - Altman, Kenneth W.

AU - Azoulay, Elie

AU - Barker, Alan F.

AU - Blackhall, Fiona

AU - Bolser, Donald C.

AU - Boulet, Louis Philippe

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Canning, Brendan J.

AU - Chang, Anne B.

AU - Cowley, Terrie

AU - Ebihara, Satoru

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Feinstein, Anthony

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Gibson, Peter

AU - Gold, Philip

AU - Gould, Michael K.

AU - Grant, Cameron

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kahrilas, Peter J.

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lane, Andrew P.

AU - Malesker, Mark A.

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - McGarvey, Lorcan

AU - Murad, M. Hassan

AU - Nguyen, Huong Q.

AU - Newcombe, Peter

AU - Oppenheimer, John

AU - Rosen, Mark

AU - Rubin, Bruce

AU - Ryu, Jay H.

AU - Smith, Jaclyn

AU - Tarlo, Susan M.

AU - Vertigan, Anne E.

AU - Wang, Gang

AU - Weinberger, Miles

AU - Weir, Kelly

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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.

AB - 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.

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