1. Comparative Evaluation of Effect of Levocloperastine Fendizoate and Codeine Phosphate on Cough Associated with Laryngopharyngeal Reflux Disease Dr. Navjot Kaur (Junior Resident), Dr. Dinesh Kumar (Assistant Professor), Dr. Gurinderjit Kaur Shergill (Assistant Professor), Dr. Jagdeepak Singh (Professor) ENT Department Govt. Medical College, Amritsar.

2. INTRODUCTION Laryngopharyngeal Reflux Disease (LPRD) is an extra-esophageal variant of gastroesophageal reflux associated with day time cough which adversely affects the quality of life of patients. Cough suppressants form an integral part of the treatment and the ideal one is still elusive.

3. OBJECTIVES To compare the effect of Levocloperastine Fendizoate and Codeine Phosphate on symptom of cough in patients with LPRD as determined by Leicester Cough Questionnaire (LCQ).

4. MATERIALS AND METHODS 100 patients of LPRD with a predominant symptom of cough were recruited. Complete ENT check up and indirect laryngoscopy was performed in every patient. LCQ was used to grade the symptom of cough before and after treatment. (1) Reflux Finding Score (RFS) was used to grade the severity of disease before and at two weeks of treatment. (2) Patients were randomly assigned to Group I (Levocloperastine Fendizoate) and Group II (Codeine Phosphate) with concomitant administration of tab. rabeperazole (20mg bd) and antacid suspension after each meal. Follow up was done at weekly intervals for two weeks.

5. Gender wise Comparison

6. Age wise Comparison

7. Reflux Finding Score

8. Mean percentage change in Reflux Finding Score from baseline at two weeks

9. Leicester Cough Questionnaire (LCQ)

10. Mean percentage change in LCQ from baseline

11. Key Observations 61% patients were females. Maximum number of patients (53%) was in 41-50 years age group followed by 19% patients in 51-60 years age group. The mean age of patients in Group I and II was 45.20 ± 9.02 and 44.08 ± 9.68 respectively. The mean LCQ score in Group I and II was 78.32 ± 3.06 and 78.22 ± 2.04 respectively before start of treatment. The mean change in LCQ score at the completion of two weeks of treatment from baseline in Group I and II was 50.70 ± 4.64 and 22.32 ± 3.45 respectively (P value <0.001). This was statistically highly significant. The mean RFS score in Group I and II before start of treatment was 11.28 ± 3.04 and 10.92 ± 3.14. The mean percentage change in RFS at the completion of two weeks of treatment was not statistically significant between the two groups.

12. Conclusions The LPRD affects females more than males. The maximum number of patient is in fifth decade of life. The results suggest that Group I patients had an early onset and sustained control of cough as compared with those in Group II. Only one patient in Group I complained of drowsiness after taking the medication while this symptom was reported by 18% patients in Group II.

13. Discussion LPRD is widely considered by otolaryngologists as a common cause of chronic cough. It can be associated with frequent throat clearing, hoarse voice, and globus (3) The diagnosis is usually based on laryngoscopic findings of erythema, edema, and thickening of the posterior pharynx that can potentially be indistinguishable from the trauma from coughing itself. (4). The therapeutic options for patients with unexplained chronic cough are limited. Opiates such as morphine sulfate can suppress cough but are associated with significant side effects such as sedation, and there is the risk of dependence (5). Levocloperastine fendizoate provides superior and early control of cough in patients of LPRD while mucosal changes caused by acid reflux show healing.

14. Bibliography 1.S.S. Birring Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ),Thorax 2003;58:339-343 doi:10.1136/thorax.58.4.339 2.Belafsky, P. C., Postma, G. N. and Koufman, J. A. (2001), The Validity and Reliability of the Reflux Finding Score (RFS). The Laryngoscope, 111: 1313– 1317. 3.Remacle M, Lawson G. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg 2006;14:143–149. 4.McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M, Shepherd DR, MacMahon J. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax 1998;53:738–743. 5.Morice AH, Menon MS, Mulrennan SA, Everett CF, Wright C, Jackson J, Thompson R. Opiate therapy in chronic cough. Am J Respir Crit Care Med 2007;175:312–315