Chronic Cough and Gastroesophageal Reflux Disease - Research Paper Example

Michelle McGuire FNP III Evidence Based Practice Paper Topic: The Association of Chronic Cough and Gastroesophageal Reflux Disease in Pediatric Population. Is there a causal link between chronic cough and GERD in pediatric patients? I. Primary research question:  1. Is there evidence to support a causal link between chronic cough and GERD in pediatric patients? 2. Has there been an increase in the prevalence of GERD in pediatric patients over the past 20-30 years, and if so, what are the proposed explanations? 3. Incidence of increased hospitalizations due to respiratory illness in pediatric patients with GERD? Description of the issue to be explored: Cough is the most common symptom for which patients seek medical attention. In adults, cough variant asthma, postnasal drip or rhinosinusitis, and gastroesophageal reflux disease (GERD) are the most common causes of chronic cough in Western countries. A positive association between cough and weakly acidic reflux was found in a significant subgroup of patients with unexplained chronic cough (Blondeau et al., 2007, p. 723) thus, the evidence in adults leads us to suspect that GERD might be increasing as a cause of chronic cough in adult patients and the causal relationship can also be established in children (Irwin, 2006, p. 81S). The relationship between chronic cough and GERD is established in several studies that have revealed that GERD, singly or in combination with other conditions, is one of the most common causes of chronic cough in adults in the world. The prevalence in these studies ranged from 5 to 41% (Irwin, 2006, p. 81S). On the contrary, another study in adults showed a positive association between cough and GERD in significant subgroup with chronic cough but was not able to identify controlled studies that evaluated association of GERD and cough in children (Tolia, 2008, p. 258. But this relationship is yet to be established in the pediatric world because few studies in pediatrics have related GERD with chronic cough in children and is still yet to be explored and if found true can help in decreasing the rate of chronic cough rate in vulnerable population of children. Adult studies suggest that gastro-esophageal reflux disease (GERD) causes 21–41% of chronic cough. In adults with chronic cough, a small study has shown a non significant increase of airway neutrophils when compared to controls. In children with underlying respiratory problems studies shows chronic cough and airway neutrophilia has been reported to occur with GERD. However, there are no prospective studies that have examined the specific relationship between cough and objectively defined GERD in children without an underlying lung disease, and pediatric cough differs significantly from adult cough (Chang et al., 2006). Chronic cough in children, due to vulnerable immune system, often leads to more serious respiratory disease such as respiratory failure that impairs a person’s normal functioning as well as exhausting family funds in diagnostics and medications for complications when caught unaware of the condition. For this matter the importance of defining the common causes of chronic cough in children might be the best solution to target the impending problem and since GERD is associated with unexplained chronic cough in adults the possibility of being in children can be a probable cause of increasing chronic cough rate in children. Cough in adult and children have differences that’s why the relationship of chronic cough and GERD in children needs to be established though clinical researches tells the relationship in adult patients (Chang & Glomb, 2006). Scope of topic The scope of the topic area will tackle on the association of chronic cough and GERD in children. Though some data may refer to results of some researches regarding chronic cough and GERD in adult patients, it is mainly for the purpose of comparison alone. The topic will not cover other conditions associated with GERD or chronic cough alone in pediatric patients to avoid misconception and for unity in the outcome of study and flow of data. Importance of the Study: Chronic cough in children has been prevalent nowadays and more often than not this leads to even more serious respiratory conditions. This topic is important to the author of this article because as a healthcare provider it is a role of a nurse to uphold the health of all people especially for people who are immune deprived such as in small children. On a personal observation and according to studies, respiratory diseases are one of the most common causes of hospitalization in children. One can tell just by going into the pediatric department of a hospital and browsing over the causes of their hospitalization and the highest probability is that most often chronic cough is always one of the causes. With this study is a hope to establish the relationship of chronic cough, one of the most common cause of mortality in children, and GERD that could help in the proper diagnosis and as well as proper treatment to prevent further complications. This is very timely and important especially for pediatric clinicians to assist them in properly diagnosing chronic cough that might be due to gastro-esophageal reflux disease and guide them in treating such conditions if the relationship be established properly by researches. And most especially the endpoint benefactor would be the pediatric patients and their parents because establishing the relationship might end up the high prevalence of chronic cough and children as well as hospitalization and death rate due to complications. This will save patients time and money due to irrelevant diagnostics due to misdiagnosis from normal respiratory diagnostics findings that could be gastric in origin. Sources: Irwin R. (2006) chronic cough due to GERD: ACCP Evidence-Based Clinical pathway Guidelines. Chest 129; 80S-94S. DOI 10.1378/chest.129.1_suppl.80S This study reviews and analyzes literature on the relationship of chronic cough and GERD in patients though not identified as pediatric patients, this study have correlated different types of study on the relationship of chronic cough and GERD. This is significant as a starting point since according to most of the studies analyzed in this study that there is a relationship with the prevalence of chronic cough with patients with GERD. That would mean established data since adult and pediatric patients do not have huge differences in anatomical structures when it comes to respiratory system and gastrointestinal system structures. According to the analysis of this study, it revealed that GERD, singly or can be in combination with other conditions, is one of the most common causes of chronic cough in adults the world. The prevalence in these studies ranged from 5 to 41%. This study have proved the causal relationship of chronic cough and GERD in adults that could be with possibility in children leading the author of this study in the move to research, study and establish the relationship of the two diseases but this time in pediatric patients by contemplating on various studies in comparison with personal analysis and conviction (2006, p. 81S). Chang A. & Glomb W. (2006) Guidelines for Evaluating Chronic Cough in Pediatrics ACCP Evidence-Based Clinical Practice Guidelines. Chest, 129; 260S-283S DOI 10.1378/chest.129.1_suppl.260S This study tackles about chronic cough in children relating it to different causes since chronic cough in children is deemed as one of the leading cause of hospitalization this study opt to help clinicians and healthcare providers in the diagnosis, treatment and management of chronic cough in children. And according to this study GERD and cough in children is not a well established relationship like in adults because proof that GERD causes chronic cough in children is rare and is yet to be backed up by research and studies. According to this study, one of the principles that disassociate GERD and cough in children is that infant regurgitate and yet few well infants cough form this episode. Though the study have mentioned the occurrence of a GERD in 4 out of 49 children in a retrospective study still the data on association is posed as complex unlike in adult patients whereby GERD is a frequent cause of chronic cough. This study posed as a challenge to further pursue studies and researches that would identify the clear line between GERD and chronic cough in children as well, even it is well defined in adults the differences among the adult and children patients in terms of diseases and management tells otherwise the disassociation of GERD and cough in children. Marchant J., Masters B., Taylor S., Cox N., Seymour G. & Chang A. (2006) Evaluation and Outcome of Young Children with chronic cough. Chest, 129; pp.1132-1141 This study was done to evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children presenting with symptoms of chronic cough. This is relevant to the scope of this study to show the association and similarities of chronic cough in adult and chronic cough in children to establish the differences in treatment. Since this study is trying to associate chronic cough in children which has an established association with chronic cough in adults according to some studies. The findings of this study highly suggest the differences in adult and children in terms of treatment of patients with asthma, GERD, and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults. Thus the established association of GERD and chronic cough in adult can otherwise set different result in the pediatric populace. This calls out for further investigation and studies in children and adult separately in terms of diagnosis and treatment since both groups have varying differences that cannot account for the other. The result of the study only shows a non significant 6% of the total population group to have a diagnosis of GERD in association with chronic cough in children. The final result of the study shows that Asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS), which are common causes of chronic cough in adults, were found in less than 10% of the children studied. Although the possibility of GERD in children as a cause of chronic cough in children cannot be totally ruled out due to presence of a little percentage still further studies should be made. This study was a help as a starting point since the presence of the percentage that associates GERD and chronic cough in children has been minimally established that suggests further evidenced based research studies. GERD in children is not a common diagnosis in the pediatric admissions in the hospital mainly because children hardly identify symptoms of acidity and abdominal pain. Most of the time when assessing children of pain the information that health care providers get are usually vague maybe because at a young age children does not often experience GERD unlike in adult who can clearly identify symptoms felt. The association of GERD in children to chronic cough if established will be a great help in treating pediatric patients especially with unexplained chronic cough since chronic cough is one of the leading cause why pediatric patients seek help. By establishing the said relationship, pediatricians can look at the possibility of GERD without doubt and can consider treating GERD in children with chronic cough as an acceptable treatment for chronic cough in children. During the first part of the study, the author’s expectation of having a high association of chronic cough and GERD in children was very high since it was already established in adult patients. Believing that though obvious differences in treatment between an adult and pediatric patient is a given fact like for example in giving medication due to weight issues but other than the obvious basic differences between an adult and pediatric patient did not affect the expectation of the author to find a significant association. Since basically adult and children share the same anatomical structures as humans that only varies in size but are basically proportional with age. The presence of a documented little percent of GERD in chronic cough in pediatric patients only tells that there is no causal relationship between GERD and Chronic cough in pediatric patients and could have been an effect of the vice versa. The little degree of association from the small percentage of the various researches studied still needs to be established by clinical research to leap another milestone in the treatment of chronic cough in children unless proven otherwise the treatment for GERD in children with chronic cough can be considered thus further studies is highly recommended to further investigate and prove the association of chronic cough and GERD in children. References: Blondeau K., Dupont L., Mertens V., Tack J. & Sifrim D. (2007) Improved diagnosis of gastro-oesophageal reflux in patients with unexplained chronic cough. Alimentary Pharmacology & Therapeutics, (25) 6, pp. 723-32 Chang A., Cox N., Faoagali J., Cleghorn J., Beem C., Ee L., Withes G., Patrick M. & Lewindon P. (2006) Cough and reflux esophagitis in children: their co-existence and airway cellularity. Retrieved from http://www.biomedcentral.com/1471-2431/6/4 Chang A. & Glomb W. (2006) Guidelines for Evaluating Chronic Cough in Pediatrics ACCP Evidence-Based Clinical Practice Guidelines. Chest, 129; 260S-283S DOI 10.1378/chest.129.1_suppl.260S Irwin R. (2006) chronic cough due to GERD: ACCP Evidence-Based Clinical pathway Guidelines. Chest, 129; 80S-94S. DOI 10.1378/chest.129.1_suppl.80S Marchant J., Masters B., Taylor S., Cox N., Seymour G. & Chang A. (2006) Evaluation and Outcome of Young Children with chronic cough. Chest, 129; pp.1132-1141 Tolia V. (2008) Systematic review: the extra-esophageal symptoms of gastro-esophageal reflux disease in children. Alimentary Pharmacological & Therapeutics, 29, pp. 258-272. Read More