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Bronchoscopy for refractory/unexplained cough with mucus.

James Wingfield Digby1, Jenny King1, Bashar Al-Sheklly2

  • 1School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.

Respiratory Medicine
|July 19, 2023
PubMed
Summary
This summary is machine-generated.

Bronchoscopy is valuable for diagnosing refractory/unexplained cough (RUCC) with mucus production. It identifies treatable conditions like neutrophilic airway inflammation and excessive dynamic airway collapse (EDAC), guiding management in these patients.

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Area of Science:

  • Pulmonology
  • Respiratory Medicine
  • Diagnostic Procedures

Background:

  • Refractory/unexplained cough (RUCC) typically presents with throat symptoms and a dry cough.
  • A subset of patients with RUCC report significant sputum production and chest sensations, with limited bronchoscopy data.
  • Characterizing bronchoscopic findings in RUCC with mucus is crucial for understanding underlying pathology.

Purpose of the Study:

  • To evaluate bronchoscopy, bronchoalveolar lavage (BAL) cell differential, and microbiology findings in RUCC patients with mucus production.
  • To identify specific treatable traits in this patient cohort.
  • To assess the impact of bronchoscopy on treatment strategies.

Main Methods:

  • Retrospective review of case notes and procedure results for patients undergoing bronchoscopy for RUCC with >1 tablespoon of daily sputum.
  • Inclusion criteria: RUCC, normal/trivial CT findings, no response to guideline-directed treatment.
  • Analysis of BAL cell differential and identification of airway collapse during bronchoscopy.

Main Results:

  • 54 patients with RUCC and mucus production were included.
  • 84% of patients showed BAL neutrophilia, indicating airway inflammation.
  • Excessive dynamic airway collapse (EDAC) was observed in 31% of patients.
  • Bronchoscopy findings influenced or changed management in 89% of patients.

Conclusions:

  • Bronchoscopy offers high diagnostic value in RUCC with significant mucus production.
  • Identifies specific treatable traits such as neutrophilic airway inflammation and EDAC.
  • Bronchoscopy findings significantly impact and guide treatment strategies for this patient group.