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Effects of Esophageal Acid Perfusion on Cough Responsiveness in Patients With Bronchial Asthma^*

^* From the Third Department of Internal Medicine (Drs. Wu, Yamauchi, Kobayashi, Tanifuji, and Inoue) and First Department of Internal Medicine (Drs. Kato and Suzuki), Iwate Medical University, School of Medicine, Morioka, Japan.

Correspondence to: Hiroshi Inoue, MD, PhD, FCCP, Chief and Professor, The Third Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru Morioka, 020 Japan; e-mail: hinoue{at}iwate-med.ac.jp

Study objectives: The effect of gastroesophageal reflux (GER) on cough responsiveness in patients with bronchial asthma has yet to be studied in significant detail. The purpose of this study was to assess the effect of distal esophageal acid perfusion on cough responsiveness in patients with bronchial asthma.

Patients and interventions: In seven patients with mild persistent bronchial asthma (mean ± SD age, 57.7 ± 3.7 years; four women and three men), esophageal pH was monitored by a pH meter and cough responsiveness was evaluated by single-breath aerosol inhalation of capsaicin with increasing dosage from 0.30 to 9.84 nmol. Simultaneously, esophageal perfusion was performed through an esophageal tube filled with either saline solution or 0.1 N hydrochloric acid (HCl), the order of which was selected at random, in 1-week intervals. Results were expressed as the lowest concentration of capsaicin eliciting three coughs (PD₃). Spirometry was also performed during esophageal pH monitoring.

Results: A significant decrease in the geometric mean of log PD₃ was observed during distal esophageal HCl perfusion (0.45 ± 0.04 nmol) compared with that of the saline solution perfusion (0.04 ± 0.06 nmol) [p < 0.01]. However, no significant changes were observed either in FVC, FEV₁, or peak expiratory flow during the periods of the saline solution or HCl perfusion.

Conclusion: The present data demonstrate that an increase in cough responsiveness may be induced when HCl stimulates the distal portion of esophagus in patients with bronchial asthma, suggesting that the GER would be one of the important factors that influence asthmatic status.

Key Words: bronchial asthma • cough responsiveness • esophageal acid perfusion • gastroesophageal reflux

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