Patient-reported respiratory symptoms and relevant factors in patients with pulmonary nodules

Pulmonary nodules (PNs) are commonly considered too small to cause respiratory symptoms. However, many PN patients present with respiratory symptoms of unknown origin. This study aims to explore these symptoms and identify the associated factors.

Demographic and clinical information were retrospectively collected from 1,633 patients with incidental PNs who visited the thoracic outpatient clinic of Guangdong Provincial People's Hospital. Hospital Anxiety and Depression Scale was used to assess their anxiety and depression level. Logistic regression analyzes were employed to assess the independent risk factors for respiratory symptoms and the psychological impact on patients.

Among the 1,633 patients, 37.2% reported at least one respiratory symptom. The most common symptoms in patients with PNs were cough (23.6%), followed by chest pain (14.0%), expectoration (13.8%) and hemoptysis (1.3%). Patients with large PNs (>20 mm) showed significantly higher odds of having cough [odds ratio (OR) =2.5; P=0.011] and expectoration (OR =3.6; P=0.001). Patients with multiple PNs were more susceptible to chest pain compared to those with solitary PNs (OR =1.5; P=0.007). Environmental factors such as passive smoking, kitchen fume pollution, environmental dust were the consistent risk contributors to the presence of these respiratory symptoms. Comparable findings were observed among the subgroup of individuals who undergo chest computed tomography scans as a part of their routine health check-up. Presence of respiratory symptoms, especially chest pain, was associated with increased the odds of anxiety (OR =2.2; P<0.001) and depression (OR =2.5; P<0.001) in patients.

Respiratory symptoms are common in PN patients, exhibiting a higher prevalence in patients with larger and multiple PNs and there is a strong association with exposure to environmental risk factors. These symptoms might exacerbate the anxiety and depression level in patients.