Differential Diagnosis for Cough

A differential diagnosis for chronic cough is gastroesophageal reflux disease (GERD). This is one of the most common causes of chronic cough in patients. Many respiratory organizations worldwide recommend the evaluation and treatment of GERD for the management of chronic cough (Kakhrilas, Smith, & Dicpinigaitis, 2014).

Presenting Symptoms

Patients normally present with heartburn, dysphagia, acid regurgitation, and an association of cough with a slouched posture. Reflux events that may trigger coughing are microaspiration of refluxate into the airways, extension of reflux into the larynx and pharynx (laryngopharyngeal reflux), or esophageal bronchial reflux (Kakhrilas, Smith & Dicpinigaitis, 2014).

Diagnostic Testing

A diagnostic test to confirm the diagnosis is an initial therapeutic trial of double-strength proton pump inhibitors (PPIs) for 8 weeks: This may require 8 weeks of double strength PPI therapy for alleviation of symptoms. This trial should not be stopped before 8 weeks and could take up to 3 months. Another test to consider is a 24-hour esophageal pH monitoring with a pH<4 that coincides with the chronic cough and is consistent with pathologic acid exposure. (Epocrates, 2019).

Treatments

Standard treatments for the cough associated with GERD are proton pump inhibitor for 8 weeks initially and can become an ongoing therapy. In addition, patients with GERD may benefit by avoiding alcohol, caffeine, nicotine, citrus, tomatoes, chocolate, and fatty foods (Domino, 2019).

References

Domino, F., Baldor, R. A., & Golding, J. (2019). The 5-minute clinical consult. (27th

Ed.). [Mobile application software.]