GERD worsens cough in fibrotic interstitial lung disease

In patients with fibrotic interstitial lung disease (ILD), the severity of cough appears to be worse in the presence of gastroesophageal reflux disease (GERD), according to a retrospective study.

Researchers looked at patients with fibrotic ILD enrolled in the Canadian Registry for Pulmonary Fibrosis. Outcomes included cough severity (assessed using the visual analogue scale [VAS]), change in lung function, and mortality.

A total 2,238 patients (mean age 66 years, 53 percent male, mean BMI 29 kg/m²) were included in the analysis, of whom 731 had idiopathic pulmonary fibrosis (33 percent), 730 had connective tissue disease-associated ILD (33 percent), 571 had unclassifiable ILD (25 percent), and 206 had fibrotic hypersensitivity pneumonitis (9 percent).

GERD was present in 777 patients (35 percent), and more than half of them (n=494, 64 percent) used a proton pump inhibitor (PPI). Baseline cough severity was significantly higher in the GERD group than the no-GERD group (median VAS, 36 vs 30 mm; p=0.007), with no difference between PPI users and nonusers (p=0.89).

Neither GERD nor PPI use showed a consistent association with change in lung function or transplant-free survival. In an analysis controlled for age, sex, BMI, and smoking pack-years, PPI use was associated with worse transplant-free survival (hazard ratio, 1.31, 95 percent confidence interval, 1.02–1.67; p=0.03).

The findings suggest that the PPIs should be used primarily for symptom control rather than for any potential impact on ILD progression.