Background A recent retrospective analysis of randomised controlled trials has suggested that patients with chronic cough reporting heartburn are more likely to benefit from acid suppressive treatment than those without heartburn.¹ Therefore we set out to investigate the response rate to acid suppression treatment (PPI and or H2 antagonists) in patients attending our specialist cough clinic.

Objective To determine the relationship between reported responses to acid suppression treatment and the presence or absence of heartburn.

Methods We performed a retrospective review of 59 consecutive new referrals to the clinic. The presence or absence of heartburn is collected routinely in our standard clinic proforma. Patients who were treated with acid suppression either at our clinic or previously at another centre were included, together with their reported response to treatment. A Fisher’s exact test was used to assess whether those with heartburn were more likely to report a response of their cough to acid suppression treatment than those without heartburn.

Results Of 59 new referrals (median age 58 (range 26–76), 44 female), 21 (35.6%) reported heartburn, whereas 38 (64.4%) did not. Forty-four subjects had completed a trial of acid suppression therapy; 7 (15.9%) reported either a partial or complete resolution of their cough, but 37 (84.0%) reported no response. Of those reporting heartburn, 5/21 (23.8%) also reported a response to acid suppression. Of those not reporting heartburn, 2/23 (8.7%) reported a response to acid suppression. Although a greater proportion of those with heartburn reported improvement of cough with acid suppression, this did not reach statistical significance (p = 0.23).

Conclusion This data suggests that in the setting of a specialist cough clinic few patients report a response of their cough to acid suppression therapy, even in the context of heartburn. However, a larger dataset is required to understand whether those with heartburn might be more likely to respond.

References

1. Karhilas PJ. Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. Chest 2013