Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report

Area of Science:

• Pulmonology
• Infectious Diseases
• Immunology

Background:

• Cough is a frequent reason for medical consultation in both general and immunocompromised populations.
• The causes of cough in immunocompromised patients with normal chest radiographs are not well-defined.
• This study addresses the diagnostic uncertainty for cough in specific patient groups.

Purpose of the Study:

• To systematically review and identify the most common causes of cough in ambulatory, immunodeficient adults with normal chest radiographs.
• To provide evidence-based guidance for the evaluation of cough in immunocompromised patients.
• To update clinical guidelines for cough management.

Main Methods:

• A systematic review of studies involving patients aged 18 years or older with immune deficiency and cough.
• Inclusion criteria specified normal or unchanged chest radiographs.
• Study relevance and quality were assessed using the American College of Chest Physicians (CHEST) methodology framework.

Main Results:

• No high-quality evidence was found to specifically guide the diagnosis of cough in immunocompromised ambulatory patients with normal chest radiographs.
• The review could not establish differences in initial cough evaluation between immunocompromised and immunocompetent individuals.
• Limited data exists on the specific etiology of cough in this patient cohort.

Conclusions:

• The initial diagnostic algorithm for cough in immunocompromised patients should be similar to that for immunocompetent individuals.
• Factors such as the type/severity of immune defect, geographic location, and social determinants are crucial considerations.
• Tuberculosis (TB) should be considered in the initial evaluation for patients with HIV and cough in high-TB prevalence areas, irrespective of radiographic findings.