Chest
Clinical InvestigationsASTHMAEffects of Esophageal Acid Perfusion on Cough Responsiveness in Patients With Bronchial Asthma
Section snippets
Patients
Seven patients with mild persistent bronchial asthma (four women and three men; mean ± SD age, 57.7 ± 3.7 years; range, 39 to 64 years) took part in the study. All patients satisfied the criteria for asthma published by the National Institutes of Health.14 We performed esophagogastroscopy on all patients in the study. The results revealed that none of the patients had esophagitis. Subjects with chronic bronchitis, allergic rhinitis, sinusitis, and postnasal drip were excluded from the study.
Results
The patients' characteristics are presented in Table 1. All patients had mild asthmatic symptoms without symptoms of GER (heartburn, regurgitation of acid into the mouth, retrosternal pain, or dysphagia). The patients had received bronchodilator therapy: sustained-release theophylline, 200 mg qd or bid (n = 7), and beclomethasone dipropionate, 400 μg bid (n = 4). None of the patients received oral corticosteroids, and all refrained from medication for 24 h before the study. Caffeine-containing
Discussion
While it has thus far remained unclear whether esophageal acid infusion itself can increase cough responsiveness in adults with bronchial asthma, results in the present study showed that cough responsiveness significantly increased after acid perfusion in the distal esophagus in patients with mild persistent bronchial asthma. To our knowledge, there has been no study to investigate the change of cough responsiveness during distal esophagus acid instillation with monitoring pH of the esophagus.
ACKNOWLEDGMENT
The authors thank Professor Michael Unher, Faculty of Education, Iwate University, for reading the manuscript, and the staff of the First Department of Internal Medicine for help with gastroesophageal fiberscopy testing.
References (26)
- et al.
The role of gastroesophageal reflux in chronic cough and asthma
Chest
(1997) - et al.
Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome
Am J Med
(1996) - et al.
Medical and surgical treatment of non-allergic asthma associated with gastroesophageal reflux
Chest
(1991) - et al.
Superior laryngeal nerve response patterns to chemical stimulation of sheep epiglottis
Brain Res
(1983) - et al.
Chronic persistent cough and clearance of esophageal acid
Chest
(1992) A critical review of the studies of the effects of simulated or real gastroesophageal reflux on pulmonary function in asthmatic adults
Chest
(1999)- et al.
Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy
Gastroenterology
(1990) - et al.
Oesophageal reflux and asthma
Eur Respir J
(1996) - et al.
Prevalence of oesophagitis in asthmatics
Gut
(1992) Intrinsic asthma in adults: association with gastroesophageal reflux
JAMA
(1976)
Chronic cough as the sole presenting manifestation of gastroesophageal reflux
Am Rev Respir Dis
Gastrooesophageal reflux and childhood asthma: the acid test
Thorax
Upper airway chemoreflex responses to saline and water in preterm infant
J Appl Physiol
Cited by (47)
Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction
2022, Allergology InternationalCitation Excerpt :Indeed, the HARQ scores reflect cough frequency and impaired cough-specific quality of life (QoL) in other chronic respiratory diseases such as cystic fibrosis11 and bronchiectasis.12 Previous studies have revealed that reflux may decrease cough threshold and increase cough reflex sensitivity.13,14 Thus, we considered that increased cough reflex sensitivity caused by reflux is associated with the worsening of asthma.
Cough reflex sensitivity does not correlate with the esophageal sensitivity to acid in patients with gastroesophageal reflux disease
2018, Respiratory Physiology and NeurobiologyChronic Cough
2015, Archivos de BronconeumologiaCitation Excerpt :In a study performed in a series of CC patients exploring the temporal association between episodes of cough, recorded by acoustic analysis, and episodes of GER, recorded by outpatient esophageal pH impedance, Smith et al.45 found that cough could appear before or after (50% of the time) episodes of GER. Wu et al.46 showed that distal esophageal acid infusion increases cough reflex sensitivity in asthmatic patients but not in normal subjects. Finally, it has been proposed recently that CC may be caused by the harmful effects of GER products on the larynx, causing laryngeal neuropathy,47,48 suggesting that CC may be a neuropathic disease caused by GER.
Cough reflex sensitization from esophagus and nose
2015, Pulmonary Pharmacology and TherapeuticsRelationship Between Gastro-Oesophageal Reflux and Airway Diseases: The Airway Reflux Paradigm
2011, Archivos de Bronconeumologia
Supported by the Ministry of Education, Science and Culture, Japan.