Chronic cough, asthma, and gastroesophageal reflux.
Gastroesophageal reflux disease (GERD) causes chronic cough and triggers asthma. Mechanisms of reflux-associated chronic cough include micro- and macroaspiration, laryngeal injury, and a vagally mediated reflex. An empiric trial of a proton pump inhibitor in patients without other etiologies of cough found through diagnostic testing may be an effective diagnostic strategy for GERD-associated cough. In GERD-associated asthma, there is evidence of neurogenic inflammation. Medical or surgical therapy of GERD results in asthma symptom improvement in about 70% of patients. A 3-month empiric trial of omeprazole, 20 mg daily, followed by esophageal pH testing in drug nonresponders, is the most cost-effective way of diagnosing asthma triggered by GERD.
Lazenby
J P
JP
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham 35294, USA.
Harding
S M
SM
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008991:Monitoring, Physiologic; D009853:Omeprazole / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D009853:Omeprazole