Airway abnormalities at flexible bronchoscopy in patients with chronic cough

The algorithms utilised in the diagnosis of chronic cough advocate sequential investigations and treatment trials for asthma-like syndromes, post-nasal drip and gastro-oesophageal reflux disease; however, the role of bronchoscopy is unclear. In the present authors' specialist clinic (North West Lung Centre Cough Clinic, Manchester, UK), flexible bronchoscopy is included in the diagnostic work-up of patients with chronic unexplained cough. In a retrospective review, the authors report on their experiences. Over an 18-month period, patients followed a diagnostic algorithm that included: chest radiography; pulmonary function; methacholine challenge; ear, nose and throat examination; and empirical reflux treatment. Where diagnosis remained elusive, bronchoscopy was performed. A total of 82 bronchoscopies were carried out for the sole indication of chronic cough. Patient age (mean+/-SD) was 54.9+/-11.22 yrs, with a median (range) cough duration of 5 (0.5-30) yrs. In nine (11%) subjects, a diagnosis was made on inspection or biopsy. These included seven cases of tracheobronchopathia osteochondroplastica (TPO), one case of elongated uvula and one case of endobronchial amyloidosis. All TPO patients had early changes, with a typical nodular appearance to the tracheal cartilage, without significant airway obstruction. These subtle changes could not have been predicted from less invasive procedures and would have been missed without bronchoscopy. Flexible bronchoscopy is indicated in persistent unexplained cough and may reveal contributing pathology.