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The role of bronchoscopy in diagnosis of chronic cough in adults: a retrospective single-center study
Affiliations- Department of Pneumology and Allergy, 1st Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
- Department of Pathobiology, 1st Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
- Department of Biology and Parasitology, 1st Chair of Biology and Medical Microbiology, Medical University of Lodz, Lodz, Poland
- Department of General and Oncological Pneumonology, 1st Chair of Internal Diseases, Medical University of Lodz, Lodz, Poland
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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
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