Proton pump inhibitors for GORD-related chronic cough in adults

If gastro-oesophageal reflux disease (GORD) is considered likely (eg patient has heartburn or regurgitation, night-time choking without symptoms of obstructive sleep apnoea, cough that is worse at night or after eating specific foods), an empirical trial of a high-dose proton pump inhibitor (PPI) may be used. See Initial therapy for GORD in adults for standard dosing of proton pump inhibitors. In the absence of gastro-oesophageal reflux symptoms, PPIs are not recommended.

Nondrug measures should be used together with the PPI trial. These include diet modification to promote weight reduction in overweight or obese patients, and lifestyle modifications (eg head of bed elevation, avoiding meals within 3 hours of bedtime). PPIs alone are unlikely to be effective in cough due to GORDKahrilas, 2016.

Review after 8 to 12 weeks and stop the PPI if there is no response.