Abstract
The aim of this study was to determine the feasibility of overnight computerized acoustic respiratory monitoring (ARM) conducted simultaneously with lower esophageal pH monitoring in infants with nighttime cough, and correlate findings with one-year clinical follow-up. Infants aged under 18 months with nocturnal cough of at least two months' duration were studied. Each child underwent 18–24 h of esophageal pH monitoring and concurrent 8–10 h nocturnal ARM. Anti-reflux therapy or inhaled corticosteroids (ICS) were prescribed according to the results. Telephone interviews with parents were conducted after one month and one year to determine respiratory symptoms and response to therapy. Eighteen infants were studied. Two had significant GER, and improved with anti-reflux therapy. ARM revealed continuous adventitious breath sounds (CABS)—wheezes, rhonchi, whistles—in 14 infants. Nine improved with ICS. Three others whose CABS had a temporal relation to short reflux "events" had incomplete response, and improved with added anti-reflux therapy. One year later, 10/14 subjects with CABS had symptoms compatible with airway hyperreactivity. ARM is a noninvasive objective method of evaluating nighttime cough in infants. In our group of infants with nocturnal cough, GER was infrequent. The most common acoustic finding was CABS, which may suggest airway hyperreactivity. Simultaneous esophageal pH monitoring may enable better discrimination between primary airway hyperreactivity and GER-associated symptoms.
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