Chronic Cough and GERD

Coughing, Snoring Among GERD Symptoms

Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart.

Most patients return to their normal activities in a couple of weeks, after a brief, one to three day hospital stay. This surgery usually costs between $12,000 and $20,000. It may also be covered by your insurance.

However, cough is frequently reported and can be debilitating;190 only limited information is available on its treatment.191 There are no randomised trials evaluating the benefit of treatment directed solely at cough. The treatment of diffuse parenchymal lung disease is outside the scope of this document and the reader is referred to the appropriate BTS guidelines on this topic (www.brit-thoracic.org.uk). Cough may be a prominent and debilitating symptom in a number of common respiratory diseases including lower respiratory tract infections (acute tracheobronchitis and pneumonia) COPD, lung cancer, diffuse parenchymal lung disease, and bronchiectasis. A chest radiograph should be undertaken in all patients with chronic cough and those with acute cough demonstrating atypical symptoms (see table 2).

Acute cough is usually caused by a viral URTI but may arise from other aetiologies such as pneumonia or aspiration of a foreign body. The duration of a single episode of URTI associated cough varies but is rarely more than 2 weeks. A cut off of 2 months for chronic cough has been arbitrarily agreed in both American10 and European guidelines.6 The economic impact of acute cough may be usefully thought of in terms of a series of patient thresholds that trigger interventions such as the purchase of a cough medicine or consultation with a general practitioner (GP).

Three studies have reported poor diagnostic and treatment outcomes in hospital based clinics where no established management algorithm for cough existed.2,108,109 The experience in such clinics markedly contrasts with the generally high treatment success attributed to the specialist approach.55,98,99,171,192 In non-specialist clinics extrapulmonary causes, particularly GORD, appears to be overlooked. All clinics managing patients with chronic cough should ensure management protocols consider pulmonary and extrapulmonary causes of cough.

People who have a history or smoking, chronic lung diseases such as COPD, asthma, seasonal allergies, acid reflux disease (Gastro esophageal Reflux Disease or GERD), lung cancer, and chronic infections such as tuberculosis, have chronic cough. Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue.

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Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungus.

Viral illnesses – it is normal to have a productive cough with a common cold. Coughing is triggered by mucus draining down the back of your throat. Certain high blood pressure (hypertension) medications such as ACE inhibitors (for example, lisinopril) can cause chronic cough syndrome, and your allergist / immunologist, working with your hypertension physician, may change your high blood pressure medication to see if your cough improves.

There are also clues that chronic cough could be related to GERD (eg, cough that occurs at night and/or postprandially, when the patient reclines, not in association with activity, and/or without the presence of postna-sal drip). RM Currently, it is very difficult to differentiate between the 2 types of cough. pH testing, pH impedance testing, and/or an upper endoscopy can be performed to look for evidence of GERD.

2006 (epub ahead of print). Unlike bronchial hyperresponsiveness, cough challenge reveals a wide range of normal cough reflex sensitivity. Cough provocation testing therefore has no clear diagnostic applications and is likely to be confined to the clinical research of cough. Failure to consider GORD as a cause of cough is a common reason for treatment failure.

Gastroesophageal reflux disease (GERD) can present with heartburn, or indigestion symptoms, and is also known as “reflux.” This can contribute to and be the cause of chronic cough syndrome. It is important to note that you may not even feel or sense the heartburn, you may simply have the cough. While there are certain procedures available to diagnose GERD, often your allergist / immunologist may place you on a GERD medication for a certain period of time and assess if your cough symptoms improve.

The 24-hour pH probe, which monitors esophageal pH, is also an effective test for people with chronic cough. Another test, known as MII-pH, can detect nonacid reflux as well. The barium swallow, once the most common test for GERD, is no longer recommended.

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Most cases of troublesome cough reflect the presence of an aggravant (asthma, drugs, environmental, gastro-oesophageal reflux, upper airway pathology) in a susceptible individual. High resolution computed tomography may be of use in patients with chronic cough in whom other more targeted investigations are normal.

This section will deal with more complex diagnostic tests where the interpretation remains open to debate, tests with largely research implications, and new innovations. Chronic cough due to gastro-oesophageal disorders has been reported in prospective studies in 5-41% of cases.97,100,110 Confusion between different diagnostic criteria, symptoms of dyspepsia, extra-oesophageal reflux, and pH monitoring make quantification of cough due to GORD difficult. Studies from general respiratory clinics have reported poor diagnostic and treatment outcomes compared with specialist cough clinics that use comprehensive management algorithms.2,108-110 Extrapulmonary causes, particularly gastro-oesophageal reflux, are frequently overlooked. The investigation of these conditions is dealt with under the specialist clinic section. Examination of the chest is not useful in differentiating reversible airflow obstruction from fixed or partially reversible airflow limitation.

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