Chronic Cough – Efficacy of Acid Suppression Therapy In Asymptomatic Gastroesophageal Reflux

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Background and Problem

Gastroesophageal reflux disease (GORD) is a common contributor towards chronic cough and is

often asymptomatic.

Current European Respiratory Society (ERS) guidelines advocate trialling acid suppression in

symptomatic cases only yet controversially asymptomatic patients may also report therapeutic

benefit [1].

Further studies are required to understand the efficacy of this intervention in both groups to reduce

the economic cost of empirical anti-acid prescriptions and address the disparity in clinical practice.

Methods

We conducted a retrospective observational study of all referrals to respiratory outpatients with

chronic cough over a 6 month period (January-June 2019).

The proportion of patients who had already been trialled on anti-acids in primary care was evaluated.

Subsequent analyses of clinic letters and investigations allowed us to assess the prevalence of

GORD and associated benefit of acid suppression in symptomatic vs asymptomatic patients.

Results

A total of 50 patients with chronic cough were reviewed. The mean age was 63 years with 60% of the

cohort being female (n=30).

42% (n=21) of patients had been empirically trialled on anti-acids by the GP previously independent

of symptoms but the dose +/- length of treatment was suboptimal.

60% (n= 30) of patients had a clear alternative diagnosis and were not offered an anti-acid trial in

respiratory clinic. Out of these 10% (n=3) had GORD coexisting with an alternative cause of chronic

cough deemed to be the underlying pathology.

40% (n=20) of patients suspected to have GORD underwent an anti-acid trial with efficacy of 71%

(n=10) in symptomatic patients and 33% (n=2) in asymptomatic patients. Co-existent disease with an

alterative diagnosis was seen in 29% (n=4) of symptomatic patients and 67%(n=4) of asymptomatic

patients