open access
The role of bronchoscopy in diagnosis of chronic cough in adults: a retrospective single-center study
open access
Abstract
Introduction: Cough is one of the most frequent symptoms reported to pulmonologists. The role of bronchoscopy in the diagnostic work-up of chronic cough is not clearly defined. The aim of this study was to evaluate the utility of fiberoptic bronchoscopy (FOB) and additional testing of samples collected during FOB in the differential diagnosis of chronic cough in adults.
Material and methods: This was a single-center retrospective study. Out of 7115 conventional white light FOB examinations, we finally selected 198 with cough as the only indication.
Results: In 40.9% of bronchoscopic examinations, no visible cause of cough was found. Visual signs of chronic bronchitis (CB) were detected in 57.6% of reports. Only in 3 cases (1.5%) bronchoscopy revealed a potential cause of chronic cough other than CB. Mycobacterium tuberculosis or other mycobacteria were spotted in none of the samples. In 91.1% of bronchoalveolar lavage (BAL) cytologic examinations, at least one cell count abnormality was detected, but only in case of increased percentage of eosinophils, it might be considered clinically relevant. In 53% of bacteriological culture results, at least one potentially pathogenic bacterium was isolated.
Conclusions: The present study results strengthen the evidence that FOB combined with additional testing of airway specimens obtained during FOB is not a powerful tool in the differential diagnosis of chronic cough, and FOB as a diagnostic tool may be overused. The appropriate timing and decision regarding referral for FOB and additional testing of achieved material requires careful clinical consideration.
Abstract
Introduction: Cough is one of the most frequent symptoms reported to pulmonologists. The role of bronchoscopy in the diagnostic work-up of chronic cough is not clearly defined. The aim of this study was to evaluate the utility of fiberoptic bronchoscopy (FOB) and additional testing of samples collected during FOB in the differential diagnosis of chronic cough in adults.
Material and methods: This was a single-center retrospective study. Out of 7115 conventional white light FOB examinations, we finally selected 198 with cough as the only indication.
Results: In 40.9% of bronchoscopic examinations, no visible cause of cough was found. Visual signs of chronic bronchitis (CB) were detected in 57.6% of reports. Only in 3 cases (1.5%) bronchoscopy revealed a potential cause of chronic cough other than CB. Mycobacterium tuberculosis or other mycobacteria were spotted in none of the samples. In 91.1% of bronchoalveolar lavage (BAL) cytologic examinations, at least one cell count abnormality was detected, but only in case of increased percentage of eosinophils, it might be considered clinically relevant. In 53% of bacteriological culture results, at least one potentially pathogenic bacterium was isolated.
Conclusions: The present study results strengthen the evidence that FOB combined with additional testing of airway specimens obtained during FOB is not a powerful tool in the differential diagnosis of chronic cough, and FOB as a diagnostic tool may be overused. The appropriate timing and decision regarding referral for FOB and additional testing of achieved material requires careful clinical consideration.
Keywords
fiberoptic bronchoscopy; cough; differential diagnosis; bacterial cultures; bronchoalveolar lavage
About this articleTitle
The role of bronchoscopy in diagnosis of chronic cough in adults: a retrospective single-center study
Journal
Advances in Respiratory Medicine
Issue
Article type
Research paper
Pages
406-411
Published online
2020-10-24
DOI
10.5603/ARM.a2020.0140
Pubmed
Bibliographic record
Adv Respir Med 2020;88(5):406-411.
Keywords
fiberoptic bronchoscopy
cough
differential diagnosis
bacterial cultures
bronchoalveolar lavage
Authors
Patryk A Sobczak
Justyna M Sobczak
Sebastian Majewski
Joanna Miłkowska-Dymanowska
Zofia Kurmanowska
Karolina Szewczyk
Ewa Tyczkowska-Sieroń
Adam J Białas
Adam Antczak
Paweł Górski
Wojciech J Piotrowski
References (20)- Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008; 371(9621): 1364–1374.
- Irwin RS, Boulet LP, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians. Chest. 1998; 114(2 Suppl Managing): 133S–181S.
- Irwin R, Madison J. The diagnosis and treatment of cough. N Engl J Med. 2000; 343(23): 1715–1721.
- Hara J, Fujimura M, Ueda A, et al. Effect of pressure stress applied to the airway on cough-reflex sensitivity in Guinea pigs. Am J Respir Crit Care Med. 2008; 177(6): 585–592.
- Smyrnios NA, Irwin RS, Curley FJ, et al. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990; 141(3): 640–647.
- Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020; 55(1).
- Benich JJ, Carek PJ. Evaluation of the patient with chronic cough. Am Fam Physician. 2011; 84(8): 887–892.
- Gasparini S. Indications for diagnostic bronchoscopy in adults. Monaldi Arch Chest Dis. 2011; 75(1): 24–31.
- Barnes TW, Afessa B, Swanson KL, et al. The clinical utility of flexible bronchoscopy in the evaluation of chronic cough. Chest. 2004; 126(1): 268–272.
- Markowitz D, Irwin R. Is bronchoscopy overused in the evaluation of chronic cough? Journal of Bronchology. 1997; 4(4): 332–336.
- Irwin R, Baumann M, Bolser D, et al. Diagnosis and management of cough executive summary. Chest. 2006; 129(1).
- Sen RP, Walsh TE. Fiberoptic bronchoscopy for refractory cough. Chest. 1991; 99(1): 33–35.
- Prakash UBS. Uncommon causes of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129(1 Suppl): 206S–219S.
- Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18(3): 268–281.
- Sen R, Walsh T. Bronchoscopy enough or too much? Chest. 1989; 96(4): 710–712.
- Lai K, Chen R, Peng W, et al. Non-asthmatic eosinophilic bronchitis and its relationship with asthma. Pulm Pharmacol Ther. 2017; 47: 66–71.
- Meyer KC, Raghu G, Baughman RP, et al. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012; 185(9): 1004–1014.
- Mund E, Christensson B, Grönneberg R, et al. Noneosinophilic CD4 lymphocytic airway inflammation in menopausal women with chronic dry cough. Chest. 2005; 127(5): 1714–1721.
- Heching M, Pertzov B, Rosengarten D, et al. Using bronchial biosies and cultures to imrove the diagnostic yield of bronchoscoy for chronic unexlained cough. B38 Issues in understing and managing cough. American Thoracic Society; 2018: A3195–A3195. doi:10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A3195. : A3195–A3195.
- Heching M, Rosengarten D, Shitenberg D, et al. Bronchoscopy for chronic unexplained cough: use of biopsies and cultures increase diagnostic yield. J Bronchology Interv Pulmonol. 2020; 27(1): 30–35.