Cough, as a symptom of interstitial lung diseases, has not received a lot of attention in the literature. Cough in scleroderma interstitial lung disease is particularly challenging. Aside from cough generated by pulmonary processes, patients often have distal esophageal dysmotility and gastroesophageal reflux,2 are taking angiotensin-converting enzyme inhibitors, and may have xerotrachea.3 In this study, there was no significant difference between subjects with sclerodoma interstitial lung disease with and without cough in terms of gastroesophageal reflux disease (GERD). Does this mean that GERD-associated cough is excluded? Patient self-reported GERD symptoms were used in the study. Objective measurements of esophageal reflux or laryngeal examination for laryngopharyngeal reflux were not included. In a study using 24-h esophageal pH impedance monitoring, pathologic reflux was more common in those with lung involvement (80%) than in those without lung involvement (59%).4 Fifty percent of subjects had silent reflux. Recently, the association of nonspecific interstitial pneumonitis with centrilobular fibrosis and foreign bodies in one-third of lung biopsy specimens from patients with scleroderma interstitial lung disease led researchers to suspect that microaspiration may be a contributor to lung disease progression.5 Can GERD-associated cough be absolutely excluded in this study? Probably not, but until there are data to suggest that microaspiration responds to cyclophosphamide, we have to discount GERD as a major trigger for cough in this study. As the authors pointed out, cyclophosphamide should not have affected cough due to GERD.