![]() Upper airway cough syndrome (UACS previously named “ postnasal drip syndrome”) ▪ There is evidence of sensitization of the cough reflex with challenge testing in GERD, which also improves with effective antireflux treatment.Ĭhronic bronchitis primarily related to cigarette smoking ▪Īngiotensin-converting enzyme (ACE) inhibitor use ▪ In some patients reflux of gastric acid up to the pharynx may account for the cough. This reflex is stimulated by infusion of acid into esophagus (Bernheim test), which is blocked, by prior lignocaine infusion and inhalation of ipratropium bromide. ![]() The mechanism of cough is activation of a local esophago-tracheobronchial neural reflex by the aspiration of gastric acid into the lower esophagus. In the absence of facilities to investigate, empiric treatment with proton pump inhibitors is indicated. If the cause of the cough is not obvious following careful clinical evaluation, chest radiology, and spirometry, and there is no response to empiric treatment for PNDS, then it is prudent to investigate for GERD (ambulatory esophageal pH monitoring, upper gastrointestinal endoscopy). Like PNDS, patients with GERD and cough frequently do not have overt symptoms of acid reflux. ![]() Lalloo, in Encyclopedia of Respiratory Medicine, 2006 Gastroesophageal reflux disease
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