Research

Cough in adult cystic fibrosis: diagnosis and response to fundoplication

Hosnieh Fathi¹ , Tanya Moon¹ , Jo Donaldson³ , Warren Jackson² , Peter Sedman⁴ and Alyn H Morice¹

¹  Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK

²  Gastro-Intestinal Physiology Laboratory, Castle Hill Hospital, Cottingham, East Yorkshire, HU16 5JQ, UK

³  Dietetics Department, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK

⁴  Division of Upper Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK

author email corresponding author email

Cough 2009, 5:1doi:10.1186/1745-9974-5-1

Published:	18 January 2009

Abstract

Background

Gastroesophageal reflux is one of the most common causes of chronic cough in the general population. Reflux occurs frequently in patients with cystic fibrosis (CF). We undertook laparoscopic Nissen fundoplication in adult CF patients with a clinical diagnosis of reflux cough who had failed conventional medical therapies.

Objective

We determined the response to the surgical route in the treatment of intractable reflux cough in CF.

Method

Patients with refractory cough were assessed by 24 h pH monitoring and oesophageal manometry. Pre-and post-operation cough, lung function and exacerbation frequency were compared. Cough was assessed by the Leicester Cough Questionnaire (LCQ), lung function by spirometry and exacerbation frequency was defined by comparing the postoperative epoch with a similar preoperatively.

Results

Significant abnormalities of oesophageal function were seen in all patients studied. 6 patients (2 females), with the mean age of 34.5 years consented to surgery. Their mean number of reflux episodes was 144.4, mean DeMeester score was 39.2, and mean lower oesophageal sphincter pressure 12.4 mmHg. There was a small change in the FEV1 from 1.03 L to 1.17 (P = 0.04), and FVC improved from 2.62 to 2.87 (P = 0.05). Fundoplication lead to a marked fall in cough with the total LCQ score increasing from 11.9 to 18.3 (P = 0.01). Exacerbation events were reduced by 50% post operatively.

Conclusion

Whilst there is an obvious attention to respiratory causes of cough in CF, reflux is also a common cause. Fundoplication is highly effective in the control of reflux cough in CF. Significant reduction in exacerbation frequency may indicate that reflux with possible aspiration is a major unrecognised contributor to airway disease.