Practice Guidelines

Reflux-Cough Syndrome: Guidelines from the ACCP


Am Fam Physician. 2017 Nov 1;96(9):611.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• If a patient's cough is likely due to GERD, treatment should consistently include lifestyle modifications and medical therapy to control reflux symptoms.

• In the absence of reflux symptoms, proton pump inhibitors should not be used alone for therapy.

• Esophageal manometry and pH-metry are recommended for certain adults with chronic cough if the cough is thought to be reflux related.

From the AFP Editors

In the decade since the American College of Chest Physicians (ACCP) last released practice guidelines on managing reflux-cough syndrome, evidence has yet to deliver the high-quality results needed to definitively answer the primary treatment questions that physicians have. In their updated guideline, the ACCP offers recommendations addressing: (1) whether treating gastroesophageal reflux disease (GERD) improves cough in patients with chronic cough, and (2) which clinical criteria suggest that chronic cough will respond to therapy.


Although a systematic review did not find any high-quality evidence to address the two main clinical questions, the ACCP found sufficient support to outline six core points of guidance.

The two most highly rated recommendations are based on low-quality evidence (e.g., findings from observational studies, case series, or flawed randomized controlled trials) and focus on nonsurgical interventions. First, if a patient's cough is likely due to GERD, treatment should consistently include promoting weight loss through diet modification in patients who are overweight or obese; counseling on sleeping with their head elevated and on meal avoidance three hours before bedtime; and initiating therapy (e.g., antacids, proton pump inhibitors, histamine H2 blockers) to control symptoms of heartburn and regurgitation. Second, if a patient has cough but no symptoms of heartburn or regurgitation, proton pump inhibitors alone are not likely to resolve the cough and should not be prescribed without coinciding lifestyle

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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