the same of the most common etiolog...

the same of the most common etiologies of chronic cough is gastroesophageal ebb disease (GERD). In up to 75 percent of patients with GERD chronic cough is the solitary presenting symptom. In addition, chronic cough caused at other etiologies may lead to GERD Cough related to GERD can be diagnosed using a 24-hour ambulatory esophageal pH monitor, although this measure is expensive and may be poorly tolerated at patients. In one study, GERD-related cough improved with the use of a high-dose proton cross-examine inhibitor. Poe and Kallay evaluated the use of proton cross-examine inhibitor therapy, with or without the addition of a prokinetic agent, in the diagnosis and treatment of GERD-related cough

The consideration included all patients with chronic cough who were referr to a university-based pulmonary clinic. Chronic cough was defined as a cough lasting three or more weeks. Patients with normal be deriveds on chest radiography were evaluated for the three principally common causes of cough--postnasal drip syndrome asthma, and GERD The evaluation was performed using an anatomic diagnostic protocol. When symptoms other than cough were not past nor future the initial evaluation was based forward those symptoms. If no symptoms recommended a cause of chronic cough investigators used a methacholine challenge ordeal and an empiric trial of an antihistamine-decongestant to diagnose asthma or postnasal drip syndrome

The remainder of patients musing to have GERD-related cough were placed upon a once-daily dosage of a proton cross-examine inhibitor. Patients who were deliberation to have esophageal dysfunction or who had an inadequate reply to the proton pump inhibitor received a prokinetic agent. Those who did not reply to this treatment plan underwent a 24-hour esophageal pH-monitoring test

Of the 183 patients with chronic cough 56 were identified as having GERD-related chronic cough In this trial, 43 percent of patients with GERD-related cough had GERD as the solitary cause of chronic cough. In addition, 43 percent of patients with GERD-related chronic cough had cough as their barely presenting symptom. The majority of patients suited to proton pump inhibitor therapy alone or in combination with a prokinetic agent. The chronic cough was eliminated or improved dramatically in 86 percent of patients after four weeks of therapy. The 12 patients who did not suit were evaluated with 24-hour esophageal pH monitoring; nine patients were plant to have some cough episodes during ebb while three patients had ebb unrelated to their chronic cough Six of the nonresponders had aspiration diagnosed from bronchoscopy.

The authors determine that four to six weeks of therapy with a proton cross-examine inhibitor, with or without the addition of a prokinetic agent, prosperously diagnoses and treats the vast majority of patients with GERD-related cough In patients who do not be agreeable to to this therapy, 24-hour esophageal pH monitoring can be used to establish ebb as the cause of chronic cough Nonresponders are also at a higher risk of aspiration.

Poe RH Kallay MC Chronic cough and gastroesophageal ebb disease. Experience with specific therapy for diagnosis and treatment. Chest March 2003;123:679-84

COPYRIGHT 2003 American Academy of Family Physicians

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