PMID- 21249664
OWN - NLM
STAT- MEDLINE
DCOM- 20110228
LR  - 20211020
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 2011
IP  - 1
DP  - 2011 Jan 19
TI  - Gastro-oesophageal reflux treatment for prolonged non-specific cough in children 
      and adults.
PG  - CD004823
LID - 10.1002/14651858.CD004823.pub4 [doi]
LID - CD004823
AB  - BACKGROUND: Gastroesophageal reflux disease (GORD) is said to be the causative 
      factor in up to 41% of adults with chronic cough. 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: We searched the Cochrane Airways Group Specialised Register, the 
      Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, review 
      articles and reference lists of relevant articles. The date of last search was 8 
      April 2010. SELECTION CRITERIA: All randomised controlled trials (RCTs) on GORD 
      treatment for cough in children and adults without primary lung disease. DATA 
      COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality 
      and extracted data. We contacted study authors for further information. MAIN 
      RESULTS: We included 19 studies (six paediatric, 13 adults). None of the 
      paediatric studies could be combined for meta-analysis. A single RCT in infants 
      found that PPI (compared to placebo) was not efficacious for cough outcomes 
      (favouring placebo OR 1.61; 95% CI 0.57 to 4.55) but those on PPI had 
      significantly increased adverse events (OR 5.56; 95% CI 1.18 to 26.25) (number 
      needed to treat for harm in four weeks was 11 (95% CI 3 to 232)). In adults, 
      analysis of H(2) antagonist, motility agents and conservative treatment for GORD 
      was not possible (lack of data) and there were no controlled studies of 
      fundoplication. We analysed nine adult studies comparing PPI (two to three 
      months) to placebo for various outcomes in the meta-analysis. Using 
      intention-to-treat, pooled data from studies resulted in no significant 
      difference between treatment and placebo in total resolution of cough (OR 0.46; 
      95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in 
      cough outcomes (end of trial or change in cough scores). We only found 
      significant differences in sensitivity analyses. We found a significant 
      improvement in change of cough scores at end of intervention (two to three 
      months) in those receiving PPI (standardised mean difference -0.41; 95% CI -0.75 
      to -0.07) using generic inverse variance analysis on cross-over trials. Two 
      studies reported improvement in cough after five days to two weeks of treatment. 
      AUTHORS' CONCLUSIONS: PPI is not efficacious for cough associated with GORD 
      symptoms in very young children (including infants) and should not be used for 
      cough outcomes. There is insufficient data in older children to draw any valid 
      conclusions. In adults, there is insufficient evidence to conclude definitely 
      that GORD treatment with PPI is universally beneficial for cough associated with 
      GORD. Clinicians should be cognisant of the period (natural resolution with time) 
      and placebo effect in studies that utilise cough as an outcome measure. Future 
      paediatric and adult studies should be double-blind, randomised controlled and 
      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.
FAU - Chang, Anne B
AU  - Chang AB
AD  - Royal Children's Hospital, Brisbane and Menzies School of Health Research, CDU, 
      Darwin, Queensland Children's Respiratory Centre and Queensland Children's 
      Medical Research Institute, Herston Road, Herston, Brisbane, Queensland, 
      Australia, 4029.
FAU - Lasserson, Toby J
AU  - Lasserson TJ
FAU - Gaffney, Justin
AU  - Gaffney J
FAU - Connor, Frances L
AU  - Connor FL
FAU - Garske, Luke A
AU  - Garske LA
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20110119
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
UOF - Cochrane Database Syst Rev. 2006;(4):CD004823. PMID: 17054216
CIN - Ann Intern Med. 2011 Jun 21;154(12):JC6-9. PMID: 21690587
MH  - Adult
MH  - Age Factors
MH  - Child
MH  - Chronic Disease
MH  - Cough/etiology/*therapy
MH  - Gastroesophageal Reflux/complications/*therapy
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Humans
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
PMC - PMC6885040
COIS- Nil.
EDAT- 2011/01/21 06:00
MHDA- 2011/03/01 06:00
PMCR- 2012/01/19
CRDT- 2011/01/21 06:00
PHST- 2011/01/21 06:00 [entrez]
PHST- 2011/01/21 06:00 [pubmed]
PHST- 2011/03/01 06:00 [medline]
PHST- 2012/01/19 00:00 [pmc-release]
AID - CD004823 [pii]
AID - 10.1002/14651858.CD004823.pub4 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Jan 19;2011(1):CD004823. doi: 
      10.1002/14651858.CD004823.pub4.