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CHRONIC COUGH |
1 Respiratory Investigation Unit, Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
2 Department of Medicine, Institute of Clinical Science, The Queen’s University, Belfast, UK
3 Department of Gastroenterology, Concord Hospital, Sydney, Australia
Correspondence to:
Correspondence to:
Dr L P A McGarvey
Senior Lecturer and Consultant Respiratory Physician, Institute of Clinical Science, The Queen’s University of Belfast, Grosvenor Road, Belfast BT12 6BJ, UK; l.mcgarvey{at}qub.ac.uk
Background: Laryngopharyngeal sensitivity (LPS) is important in preventing pulmonary aspiration and may be impaired by anaesthesia and stroke. It has been suggested that gastro-oesophageal reflux disease (GORD) may also impair LPS, although the underlying mechanism is unclear. The aim of this study was to compare LPS in patients with chronic cough and GORD with healthy subjects and to determine the effect of laryngopharyngeal infusions of both acid and normal saline on LPS.
Methods: Fifteen patients with chronic cough and GORD and 10 healthy subjects without GORD underwent LPS testing using the fibreoptic endoscopic evaluation of swallowing with sensory testing (FEESST) technique. LPS, as measured by the lowest air pressure required to elicit the laryngeal adductor reflex (LAR), was determined both before and after laryngopharyngeal infusions of normal saline and 0.1 N hydrochloric acid performed on separate days.
Results: The mean baseline LAR threshold of the patient group was significantly higher (9.5 mm Hg, range 6.0–10.0) than in normal subjects (3.68 mm Hg, range 2.5–5.0; p<0.01). Retest thresholds were not significantly different. In normal subjects LAR thresholds were significantly raised after acid but not after saline infusion (p = 0.005). There were no complications associated with the procedure.
Conclusions: Patients with cough and GORD have significantly reduced LPS to air stimuli compared with healthy subjects which could potentially result in an increased risk of aspiration. Exposure to small amounts of acid significantly impaired the sensory integrity of the laryngopharynx.
Abbreviations: GORD, gastro-oesophageal reflux disease; LAR, laryngeal adductor reflex; LPS, laryngopharyngeal sensitivity
Keywords: laryngopharyngeal sensitivity; gastroesophageal reflux; cough
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