0
Communications to the Editor |

A Possible Pathologic Link Between Chronic Cough and Sleep Apnea Syndrome Through Gastroesophageal Reflux Disease in Older People FREE TO VIEW

Shinji Teramoto, MD, FCCP; Yasuyoshi Ouchi, MD
Author and Funding Information

Department of Geriatric Medicine Tokyo University Hospital Tokyo, Japan

Correspondence to: Shinji Teramoto, MD, FCCP, Department of Geriatric Medicine, Tokyo University Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo, Japan 113-8655; e-mail: shinjit@umin.ac.jp



Chest. 2000;117(4):1215-1216. doi:10.1378/chest.117.4.1215
Text Size: A A A
Published online

To the Editor:

In a recent issue of CHEST (August 1999), Palombini and colleagues1 reported that asthma, postnasal drip syndrome (PNDS), and gastroesophageal reflux disease (GERD), alone or in combination, were responsible for > 90% of the causes of chronic cough. They proposed that asthma, PNDS, and GERD should be called a pathologic triad in chronic cough.1Because cough is the most common symptom for which adult patients seek medical attention from primary care physicians, and because cough is associated with deterioration in patients’ quality of life,2 the study of Palombini et al is very important, not only for assessing chronic cough, but also for determining therapeutic strategies for patients with chronic cough.13

However, in older patients, the causes of chronic cough may be more complicated. Age-related changes in cough reflex may affect the causes and therapeutic efficacy of chronic cough.46 Further, the protective role of cough as the defense mechanism of aspiration is very important for the pathogenesis of chronic cough in older patients.79 We have recently reported that gastroesophageal reflux (GER) is frequently found in obstructive sleep apnea syndrome (OSAS) in the elderly.10Indeed, many patients with OSAS complain of sleep-related heartburn and regurgitation of gastric contents into the pharynx.11It has been reported that treatment with nasal continuous positive airway pressure at night can correct the sleep apnea-related GER in patients with OSAS.12We have also reported that the swallowing reflex is impaired in patients with OSAS,13suggesting that OSAS may perturb the inspiratory-expiratory transition during deglutition in the patients. Because OSAS and GER may aggravate bronchial asthma, it is more difficult to control asthma in such patients.1415 In these patients, treatment with nasal continuous positive airway pressure at night is sometimes reported to improve control of asthma.1415 These observations indicate that OSAS may be a cause of chronic cough through GERD in the elderly. Because GERD manifests a spectrum of conditions, including asthma, posterior laryngitis, and chronic coughing, the cause of GERD is not always simply determined in older people.

Owing to the explosive growth of the older population, we are seeing many more elderly patients with pulmonary disease. Because the incidence of OSAS increases with age, a possible pathologic link between chronic cough and sleep apnea syndrome through GERD should be carefully considered in the treatment of elderly patients.

References

Palombini, BC, Villanova, CAC, Araujo, E, et al (1999) A pathologic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease.Chest116,279-284. [PubMed] [CrossRef]
 
French, CL, Irwin, RS, Curley, FJ, et al Impact of chronic cough on quality of life.Arch Intern Med1998;158,1657-1661. [PubMed]
 
Irwin, RS, Boulet, LP, Cloutier, MM, et al Managing cough as a defense mechanism and as a symptom.Chest1998;114,133S-181S. [PubMed]
 
Pontopiddan, H, Beecher, HK Progressive loss of protective reflexes in the airway with the advancing age.JAMA1960;174,2209-2013. [PubMed]
 
Sekizawa, K, Ujiie, Y, Itabashi, S, et al Lack of cough reflex in patients with aspiration pneumonia [letter].Lancet1990;335,1228-1229
 
Teramoto, S, Matsuse, T, Ouchi, Y Clinical significance of cough as a defence mechanism or a symptom in elderly patients with aspiration and diffuse aspiration bronchiolitis [letter].Chest1999;115,602-603. [PubMed]
 
Kobayashi, H, Sekizawa, K, Sasaki, H Aging effects on swallowing reflex [letter]. Chest. 1997;;111 ,.:1466
 
Matsuse, T, Oka, T, Kida, K, et al Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly.Chest1996;110,1289-1293. [PubMed]
 
Teramoto, S, Matsuse, T, Ouchi, Y Foreign body aspiration into the lower airways may not be unusual in older adults [letter].Chest1998;113,1733-1734. [PubMed]
 
Teramoto, S, Ohga, E, Matsui, H, et al Obstructive sleep apnea syndrome may be a significant cause of gastroesophageal reflux disease in older people.J Am Geriatr Soc1999;47,1273-1274. [PubMed]
 
Samelson, CF Gastroesophageal reflux and obstructive sleep apnea.Sleep1989;12,475-476. [PubMed]
 
Kerr, P, Shoenut, JP, Miller, T, et al Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome.Chest1992;101,1539-1544. [PubMed]
 
Teramoto, S, Sudo, E, Ohga, E, et al Impaired swallowing reflex in patients with obstructive sleep apnea syndrome.Chest1999;116,17-21. [PubMed]
 
Stein, MR Advances in the approach to gastroesophageal reflux (GER) and asthma.J Asthma1999;36,309-314. [PubMed]
 
Bruno, G, Graf, U, Andreozzi, P Gastric asthma: an unrecognized disease with an unsuspected frequency.J Asthma1999;36,315-325. [PubMed]
 

Figures

Tables

References

Palombini, BC, Villanova, CAC, Araujo, E, et al (1999) A pathologic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease.Chest116,279-284. [PubMed] [CrossRef]
 
French, CL, Irwin, RS, Curley, FJ, et al Impact of chronic cough on quality of life.Arch Intern Med1998;158,1657-1661. [PubMed]
 
Irwin, RS, Boulet, LP, Cloutier, MM, et al Managing cough as a defense mechanism and as a symptom.Chest1998;114,133S-181S. [PubMed]
 
Pontopiddan, H, Beecher, HK Progressive loss of protective reflexes in the airway with the advancing age.JAMA1960;174,2209-2013. [PubMed]
 
Sekizawa, K, Ujiie, Y, Itabashi, S, et al Lack of cough reflex in patients with aspiration pneumonia [letter].Lancet1990;335,1228-1229
 
Teramoto, S, Matsuse, T, Ouchi, Y Clinical significance of cough as a defence mechanism or a symptom in elderly patients with aspiration and diffuse aspiration bronchiolitis [letter].Chest1999;115,602-603. [PubMed]
 
Kobayashi, H, Sekizawa, K, Sasaki, H Aging effects on swallowing reflex [letter]. Chest. 1997;;111 ,.:1466
 
Matsuse, T, Oka, T, Kida, K, et al Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly.Chest1996;110,1289-1293. [PubMed]
 
Teramoto, S, Matsuse, T, Ouchi, Y Foreign body aspiration into the lower airways may not be unusual in older adults [letter].Chest1998;113,1733-1734. [PubMed]
 
Teramoto, S, Ohga, E, Matsui, H, et al Obstructive sleep apnea syndrome may be a significant cause of gastroesophageal reflux disease in older people.J Am Geriatr Soc1999;47,1273-1274. [PubMed]
 
Samelson, CF Gastroesophageal reflux and obstructive sleep apnea.Sleep1989;12,475-476. [PubMed]
 
Kerr, P, Shoenut, JP, Miller, T, et al Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome.Chest1992;101,1539-1544. [PubMed]
 
Teramoto, S, Sudo, E, Ohga, E, et al Impaired swallowing reflex in patients with obstructive sleep apnea syndrome.Chest1999;116,17-21. [PubMed]
 
Stein, MR Advances in the approach to gastroesophageal reflux (GER) and asthma.J Asthma1999;36,309-314. [PubMed]
 
Bruno, G, Graf, U, Andreozzi, P Gastric asthma: an unrecognized disease with an unsuspected frequency.J Asthma1999;36,315-325. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543