PURPOSE: Chronic cough is a common clinical problem. The sentinel paper by Irwin et al. (1981) and subsequent studies have shown that the three most common causes of chronic non-productive cough in non-smokers are post-nasal drip, gastroesophageal reflux, and hyperirritable airways (“cough-variant asthma”). Many patients fail to respond to empiric therapy directed against these causes of chronic cough. We hypothesized that subclinical dysphagia favoring aspiration in some of these patients might be a co-factor contributing to therapeutic failure.
METHODS: Patients with chronic cough (> 4 weeks) were referred for Modified Barium Swallow by speech therapy if they met these criteria: 1) Minimal sputum production; 2) non-smoker; 3) no evidence for infection or malignancy; 4) failure to respond to therapy directed against the most common causes of chronic cough. Swallowing was tested for liquids and solids of various consistencies. Lateral and anterior-posterior fluoroscopic views were recorded.
RESULTS: Twenty-one women and five men have been studied. Median age was 61 (Range 32-81). The Modified Barium Swallow was normal in only three patients. Various manifestations of dysphagia were observed as follows: Esophageal backflow - 13 patients; Vallecula/piriform pooling - 14 patients; Abnormal peristalsis - 8 patients; Zenker’s diverticulum - 2 patients; Premature spillage - 1 patient; Penetration into glottis - 3 patients; Delayed swallow - 1 patient; Failure of UES to contract - 2 patients.
CONCLUSION: Mild dysphagia is frequent in patients with chronic cough unresponsive to therapy and may contribute to treatment failure.
CLINICAL IMPLICATIONS: Swallow training by speech therapy and diet modification may help such patients.
DISCLOSURE: Gerard Frank, None.