Effects of Esophageal Acid Perfusion on Cough Responsiveness in Patients With Bronchial Asthma

Wu, Denan; Yamauchi, Kohei; Kobayashi, Hitoshi; Tanifuji, Yukio; Kato, Chieko; Suzuki, Kazuyuki; Inoue, Hiroshi

doi:10.1378/chest.122.2.505

Cited by 45 publications

(35 citation statements)

References 22 publications

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“…This effect was also observed in asthma patients without cough or GERD. 21 These findings support the concept that this reflex may not be the sole mechanism of reflux cough and that some airway disease may be needed for cough sensitivity to occur. Although in chronic cough patients, proximal esophageal reflux episodes do not seem to be different than in healthy volunteers, 22 microaspiration of gastric content into the airways is considered to be one of the causes of cough.…”

Section: Discussionsupporting

confidence: 65%

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Özdemir

Erdinç

Vardar

et al. 2017

J Neurogastroenterol Motil

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Background/AimsGastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages (LLMs) in bronchoalveolar lavage (BAL) specimens. MethodsA total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. ResultsPatients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). ConclusionsOur results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, BAL and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to antireflux medications or surgery in patients with LLM positivity.

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Section: Discussionsupporting

confidence: 65%

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Özdemir

Erdinç

Vardar

et al. 2017

J Neurogastroenterol Motil

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“…Furthermore, glottal closure during expiration may support an exaggerated protection or hypervigilant state of the airway. Nevertheless, glottal closure increases airway resistance and alters respiratory mechanics during esophageal provocation, such as GERD (28)(29)(30). Further studies are needed to evaluate esophageal-glottal interactions in order to understand the pathophysiology of chronic lung disease of infancy.…”

Section: Discussionmentioning

confidence: 99%

Esophago-Glottal Closure Reflex in Human Infants: A Novel Reflex Elicited With Concurrent Manometry and Ultrasonography

Jadcherla

Gupta

Coley

et al. 2007

Am J Gastroenterology

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“…GERD is a well recognized cause of chronic cough (see Pauwels et al, 2009), and antireflux surgery eliminates chronic cough in a subset of patients with GERD (Hoppo et al, 2013). Yet, intraluminal esophageal challenge with capsaicin or acids causes only pain but no cough response in humans (Wu et al, 2002). The pH challenge in the esophagus, however, sensitizes the cough response to inhaled capsaicin (Ing and Ngu, 1999).…”

Section: B Transient Receptor Potential Channels Inmentioning

confidence: 99%

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

2014

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Effects of Esophageal Acid Perfusion on Cough Responsiveness in Patients With Bronchial Asthma

Cited by 45 publications

References 22 publications

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Esophago-Glottal Closure Reflex in Human Infants: A Novel Reflex Elicited With Concurrent Manometry and Ultrasonography

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

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