PMID- 15846735
OWN - NLM
STAT- MEDLINE
DCOM- 20050719
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2005 Apr 18
TI  - Gastro-oesophageal reflux treatment for prolonged non-specific cough in children 
      and adults.
PG  - CD004823
AB  - BACKGROUND: Cough is a very common symptom presenting to medical practitioners. 
      Gastroesophageal reflux disease (GORD) is said to be the causative factor in up 
      to 41% of adults with chronic cough. However cough and GORD are common ailments 
      and their co-existence by chance is high. Also cough can induce reflux episodes. 
      Treatment for GORD includes conservative measures (diet manipulation), 
      pharmaceutical therapy (motility or prokinetic agents, H(2) antagonist and proton 
      pump inhibitors (PPI)) and fundoplication. OBJECTIVES: To evaluate the efficacy 
      of GORD treatment on chronic cough in children and adults with GORD and prolonged 
      cough that is not related to an underlying respiratory disease i.e. non-specific 
      chronic cough. SEARCH STRATEGY: The Cochrane Register of Controlled Trials 
      (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and 
      Cochrane Airways Group, MEDLINE and EMBASE databases, review articles and 
      reference lists of relevant articles were searched. The date of last search was 
      4th April 2004. SELECTION CRITERIA: All randomised controlled trials on GORD 
      treatment for cough in children and adults without primary lung disease. DATA 
      COLLECTION AND ANALYSIS: Results of searches were reviewed against pre-determined 
      criteria for inclusion. Two independent reviewers selected, extracted and 
      assessed data for inclusion. Authors were contacted for further information. Data 
      was analysed as "intention to treat" as well as "treatment received". Paediatric 
      and adults data were considered separately. Sensitivity analyses were performed. 
      MAIN RESULTS: 11 studies (3 paediatric, 8 adults; 383 participants) were 
      included. None of the paediatric studies could be included in meta-analysis. In 
      adults, analysis on use of H(2) antagonist, motility agents and conservative 
      treatment for GORD were not possible (from lack of data) and there were no 
      controlled studies on fundoplication as an intervention. Five adult studies 
      comparing PPI (2-3 months) to placebo were analysed for various outcomes in the 
      meta-analysis. Enrollment of subjects for two studies were primarily from medical 
      clinics and another three studies were otolaryngeal clinic patients. Using 
      "intention to treat", pooled data from three studies resulted in no significant 
      difference between treatment and placebo in total resolution of cough. Pooled 
      data revealed no significant improvement in cough outcomes (end of trial or 
      change in cough scores). Significant differences were only found in sensitivity 
      analysis. A significant improvement in change of cough scores was found in end of 
      intervention (2-3 months) in those receiving PPI with a standardised mean 
      difference of -0.41 (95%CI -0.75, -0.07) using GIV analysis on cross over trials. 
      Two studies reported improvement in cough after 5 days to 2 weeks of treatment. 
      Significant heterogeneity was found between studies using omeprazole and other 
      PPIs. AUTHORS' CONCLUSIONS: There is insufficient evidence to definitely conclude 
      that GORD treatment with PPI is beneficial for cough associated with GORD in 
      adults. The beneficial effect was only seen in sub-analysis and its effect was 
      small. The optimal duration of such a trial of therapy to evaluate response could 
      not be ascertained in the meta-analysis although two RCTs reported significant 
      change by two weeks of therapy. Clinicians should be cognisant of a period 
      (natural resolution with time) and placebo effect in studies that utilise cough 
      as an outcome measure. Data in children are inconclusive. Future paediatric and 
      adult studies are needed whereby studies should be double blind, randomised 
      controlled, parallel design, using treatments for at least two months, with 
      validated subjective and objective cough outcomes and include ascertainment of 
      time to respond as well as assessment of acid and/or non acid reflux whilst on 
      therapy.
FAU - Chang, A B
AU  - Chang AB
AD  - Respiratory Medicine, Royal Children's Hospital, Herston Road, Herston, Brisbane, 
      Queensland, Australia, 4029. annechang@ausdoctors.net
FAU - Lasserson, T J
AU  - Lasserson TJ
FAU - Gaffney, J
AU  - Gaffney J
FAU - Connor, F L
AU  - Connor FL
FAU - Garske, L A
AU  - Garske LA
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20050418
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
SB  - IM
CIN - Evid Based Nurs. 2006 Jul;9(3):73. PMID: 16862734
UIN - Cochrane Database Syst Rev. 2006;(4):CD004823. PMID: 17054216
MH  - Adult
MH  - Child
MH  - Chronic Disease
MH  - Cough/complications/*therapy
MH  - Gastroesophageal Reflux/complications/*therapy
MH  - Humans
MH  - Randomized Controlled Trials as Topic
RF  - 78
EDAT- 2005/04/23 09:00
MHDA- 2005/07/20 09:00
CRDT- 2005/04/23 09:00
PHST- 2005/04/23 09:00 [pubmed]
PHST- 2005/07/20 09:00 [medline]
PHST- 2005/04/23 09:00 [entrez]
AID - 10.1002/14651858.CD004823.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004823. doi: 
      10.1002/14651858.CD004823.pub2.