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Obesity Predicts Treatment Response to Proton Pump Inhibitor Therapy in Patients with Chronic Cough

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Abstract

Background

Chronic cough management is challenging as this condition is often associated with multiple comorbidities, requiring a multidisciplinary diagnostic approach. Little is known about the characteristics of obese patients with chronic cough. This study aims to describe treatable traits of chronic cough and the response to pump proton inhibitor (PPI) therapy in this sub-group of patients.

Methods

A retrospective, observational study was performed in patients with chronic cough in a French University Hospital. Characteristics of chronic cough were analyzed for obese (N = 112) and non-obese (N = 355) patients. Refractory cough was estimated at 6 and 12 months.

Results

The 3 main treatable traits associated with chronic cough in obese patients and non-obese patients were gastroesophageal reflux disease (GERD), asthma, and upper airway cough syndrome (UACS). A noticeable difference was the higher frequency of GERD (47.3% vs 34.6%, p = 0.0188) and obstructive sleep apnea (OSA) (9.8% vs 3.1%, p = 0.0080) in obese patients compared to non-obese patients. Pump proton inhibitor (PPI) treatment had a significantly higher success rate in obese patients (32.5% vs 17.0%, p < 0.05) and refractory cough at 12 months was less frequently reported in obese patients (22.3% vs 34.1%, p < 0.05).

Conclusion

In a context of chronic cough, a higher prevalence of GERD was noted in obese patients compared to non-obese patients and obese patients were more responsive to PPI treatment. Moreover, OSA was reported more frequently as a treatable trait in obese patients and should be considered early in the diagnostic evaluation. Prospective clinical studies that evaluate the contribution of obesity to chronic cough are further needed.

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Abbreviations

BMI:

Body mass index

FeNO:

Fractional exhaled nitric oxide

GERD:

Gastroesophageal reflux disease

OSA:

Obstructive sleep apnea

PPI:

Proton pump inhibitor

UACS:

Upper airway cough syndrome

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Acknowledgements

The authors are grateful to Cécile Desjobert and Marielle Romet (Santé Active Edition) who provided medical writing assistance funded by MSD France.

Funding

None.

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Authors and Affiliations

  1. Department of Respiratory Medicine, University Hospital Centre of Toulouse, Toulouse, France

    Mathilde Descazeaux, Danièle Brouquières, Alain Didier, Marianne Lescouzères, Roger Escamilla & Laurent Guilleminault

  2. Centre for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France

    Alain Didier & Laurent Guilleminault

  3. Clinique Rive Gauche, Toulouse, France

    Marie-Françoise Napoléon

Authors
  1. Mathilde Descazeaux
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  7. Laurent Guilleminault
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Contributions

MD and LG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. DB, AD, ML, MFN, RE and LG contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Corresponding author

Correspondence to Laurent Guilleminault.

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Conflict of interest

Mathilde Descazeaux and Marianne Lescouzères have no conflict of interests. Danièle Brouquières has participated in clinical trials sponsored by Astra Zeneca, MSD, ZAMBON and NOVARTIS. Alain Didier has received consultation fees from ALK, Astrazenenca, Chiesi, GlaxoSmithKline, Novartis Boerhinger Ingelheim, Menarini, and Zambon. Marie-Françoise Napoléon has received non-financial support by Alphasigma and has participated in clinical trials sponsored by Mayoli Spindler. Roger Escamilla has received consultation fees from MSD, Novartis and Boerhinger Ingelheim. Laurent Guilleminault has received consultation fees from ALK, Astrazenenca, Bayer, Chiesi, GlaxoSmithKline, Novartis and Boerhinger Ingelheim and non-financial support from ALK, Astrazenenca, Boerhinger Ingelheim, Novartis and Pierre Fabre. Laurent Guilleminault has received grants from Axdom Réunion, ISIS Réunion, Resmed and Seprodom.

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Descazeaux, M., Brouquières, D., Didier, A. et al. Obesity Predicts Treatment Response to Proton Pump Inhibitor Therapy in Patients with Chronic Cough. Lung 198, 441–448 (2020). https://doi.org/10.1007/s00408-020-00359-w

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  • DOI: https://doi.org/10.1007/s00408-020-00359-w

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