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Xianghuai Xu, MD; Qiang Chen, MD; Siwei Liang, MD; Hanjing Lv, MD; Zhongmin Qiu, MD, PhD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine.

Correspondence to: Zhongmin Qiu, MD, PhD, FCCP, Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Rd, Shanghai 200065, China; e-mail: qiuzhongmin@tongji.edu.cn


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):e32-e33. doi:10.1378/chest.14-0674
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To the Editor:

We thank Drs Jiang and Mao for their insightful comments regarding our recent article.1 The goal of the study is to select the appropriate patients for empirical antireflux trial and to improve therapeutic gains. Actually, the patients were lifetime nonsmokers or ex-smokers for at least 2 years. The patients received an initial laboratory workup that included all the examinations Drs Jiang and Mao mentioned except for those patients with the obvious reflux-related symptoms, who accepted the evaluation of gastroesophageal reflux-induced chronic cough (GERC). Therefore, no other common causes of chronic cough were identified or were the explanation for their cough in the patients with potential GERC when recruited. Because of the limit of words in the text, we did not describe the relevant laboratory investigations in detail.

GERC can only be confirmed by the favorable response to antireflux therapy, irrespective of laboratory findings.2 Acid suppressive therapy is the mainstay for the management of GERC,2 whereas body weight loss and lifestyle modification are conditionally recommended in some patients for long-term management of the disorder.3 Although currently there is controversy, the use of acid suppressive therapy for GERC is favorably concluded in a recent systematic review4 and recommended in a recent guideline for the management of gastroesophageal reflux disease.3 This is supported by our data that standard acid suppression resolved the cough in most patients with GERC, and only one-fourth of patients needed an intensified antireflux trial. We agree with Drs Jiang and Mao that further study is necessary to definitely define the benefit of acid suppression in GERC.

In our study, 33 patients with GERC (32.4%) had other concomitant causes of chronic cough. Among eight responders to baclofen as an add-on therapy, one patient had concomitant cough variant asthma plus upper airway cough syndrome, one patient had concomitant eosinophilic bronchitis, and the remaining six patients had no other causes other than GERC to be identified. We agree with Drs Jiang and Mao that cough induced by any causes may respond to baclofen because of its nonspecific antitussive activity. However, the patients had objective laboratory evidence of abnormal reflux and only partially responded to previous therapies specific to the concomitant causes. Therefore, we believe the improvement in cough, at least partially, can be attributed to GERC, since baclofen has an established antireflux effect through the inhibition of transient lower esophageal sphincter relaxations.3,5

References

Xu X, Chen Q, Liang S, Lv H, Qiu Z. Comparison of Gastroesophageal Reflux Disease Questionnaire and multichannel intraluminal impedance pH monitoring in identifying patients with chronic cough responsive to antireflux therapy. Chest. 2014;145(6):1264-1270. [CrossRef] [PubMed]
 
Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):80S-94S. [CrossRef] [PubMed]
 
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-328. [CrossRef] [PubMed]
 
Kahrilas PJ, Howden CW, Hughes N, Molloy-Bland M. Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. Chest. 2013;143(3):605-612. [CrossRef] [PubMed]
 
Xu XH, Yang ZM, Chen Q, et al. Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough. World J Gastroenterol. 2013;19(27):4386-4392. [CrossRef] [PubMed]
 

Figures

Tables

References

Xu X, Chen Q, Liang S, Lv H, Qiu Z. Comparison of Gastroesophageal Reflux Disease Questionnaire and multichannel intraluminal impedance pH monitoring in identifying patients with chronic cough responsive to antireflux therapy. Chest. 2014;145(6):1264-1270. [CrossRef] [PubMed]
 
Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1_suppl):80S-94S. [CrossRef] [PubMed]
 
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-328. [CrossRef] [PubMed]
 
Kahrilas PJ, Howden CW, Hughes N, Molloy-Bland M. Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. Chest. 2013;143(3):605-612. [CrossRef] [PubMed]
 
Xu XH, Yang ZM, Chen Q, et al. Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough. World J Gastroenterol. 2013;19(27):4386-4392. [CrossRef] [PubMed]
 
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