Thus, I congratulate Kahrilas et al19 for improving our understanding of GERD-related chronic cough. We need to acknowledge that our tests are imperfect; prior studies had heterogeneous study designs, which make determining a causal link between GERD and chronic cough difficult. As well, there is a strong possibility that a patient with chronic cough initially presumed to be GERD related may actually not have GERD as the etiology for their symptoms. Lack of response to empirical PPI therapy should not be followed by escalating treatment of GERD, because this seldom is beneficial. A search for allergy, sinus, pulmonary disease, or other causes should be entertained. We need to better understand the natural history of GERD-related chronic cough and conduct large-scale controlled trials with PPIs with more reliable, objective measures.