Study: Deep Diaphragmatic Breathing Enhances Cough Resolution in Patients with Gastroesophageal Reflux-Induced Chronic Cough

In a randomized controlled trial, researchers found that deep diaphragmatic breathing training (DEP) improves cough symptoms in patients with gastroesophageal reflux-induced chronic cough (GERC). Patients with GERC who received DEP training in addition to routine medication demonstrated a 94% cough resolution rate, compared to 77% in the control group (P = .041).

GERC is a common but under-recognized cause of chronic cough that is often resistant to conventional treatments. Chronic cough can affect quality of life, and its association with gastroesophageal reflux disease (GERD can complicate treatment. This study aimed to address the need for alternative, non-pharmacological interventions to alleviate persistent cough in patients with GERC, particularly those who may not fully respond to routine medical therapy.

In this study, 60 patients with GERC were randomly assigned to either an intervention group (n = 30) or a control group (n = 30). Both groups received standard pharmacological treatments for GERC, but the intervention group also underwent DEP training. The study assessed several parameters before and after 8 weeks of treatment, including cough symptom scores, Hull airway reflux questionnaire (HARQ), gastroesophageal reflux diagnostic questionnaire (GerdQ), generalized anxiety disorder scale-7 (GAD-7), patient health questionnaire-9 (PHQ-9), Pittsburgh sleep quality index (PSQI), the Leicester cough questionnaire (LCQ), capsaicin cough sensitivity testing, B-ultrasound, and surface electromyography (sEMG) of the diaphragmatic muscles.

After 8 weeks, the intervention group demonstrated better outcomes than the control group in several domains. Besides the improved cough resolution rate, the intervention group had lower GerdQ scores (6.13 vs 6.57), lower GAD-7 scores (median 0 vs 1), lower PSQI scores (median 2 vs 4), and higher LCQ scores (17.19 vs 15.88). Diaphragmatic muscle activity measured by sEMG also showed a greater increase in the intervention group, both during deep diaphragmatic breathing (79.00 vs 74.65) and quiet breathing (72.73 vs 67.15). These results suggest that DEP not only reduces cough but also improves GERD-related symptoms, anxiety, sleep quality, and overall quality of life.

One limitation of the study is the relatively small sample size. Additionally, the study duration was only 8 weeks, and it remains unclear whether the benefits of DEP are sustained over longer periods or how adherence to DEP training affects outcomes in the long term.

“DEP training can improve cough symptoms as an adjunctive treatment in GERC patients,” the study authors concluded.

Reference

Niu S, Zhang T, Li W, et al. Positive effect of deep diaphragmatic breathing training on gastroesophageal reflux-induced chronic cough. Respir Res. 2024;25(1):169. doi:10.1186/s12931-024-02783-5.