Rosen Mark J, Ireland Belinda, Narasimhan Mangala, French Cynthia, Irwin Richard S
Icahn School of Medicine at Mount Sinai, New York NY.
TheEvidenceDoc, Pacific, MO.
Chest. 2017 Nov;152(5):1038-1042. doi: 10.1016/j.chest.2017.07.039. Epub 2017 Aug 19.
Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems.
We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework.
The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs.
Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing.
咳嗽是促使患者就医的常见症状。与普通人群中的患者一样，免疫系统受损的患者也会因咳嗽而寻求治疗。然而，对于那些被认为不太可能患有危及生命的疾病且胸部X光片正常或无变化的免疫功能低下患者，咳嗽的原因是否与免疫功能正常的咳嗽患者相似尚不清楚。
我们进行了一项系统评价，以回答以下问题：胸部X光片正常的非卧床免疫缺陷成年患者咳嗽的最常见原因是什么？纳入了对年龄≥18岁、有免疫缺陷、咳嗽持续时间不限且胸部X光片正常或无变化的患者的研究，并对其相关性和质量进行评估。基于系统评价，使用美国胸科医师学会（CHEST）的方法框架制定并投票表决了相关建议。
系统评价的结果显示，没有高质量的证据可指导临床医生确定胸部X光片正常的非卧床免疫功能低下患者咳嗽的可能原因。
基于系统评价，我们没有发现证据来评估免疫功能低下患者咳嗽的初始评估是否与免疫功能正常者不同。专家小组的共识表明，初始诊断算法应与免疫功能正常者相似，但应考虑免疫缺陷的类型和严重程度、地理位置及社会决定因素等背景情况。对2006年CHEST咳嗽指南的主要修改建议是，居住在结核病高流行地区的咳嗽合并HIV感染患者，无论影像学表现如何，结核病都应作为初始评估的一部分；对于初始评估无结果的所有患者，都应考虑特定病因和免疫缺陷。
