Chopra Manu, Bhattacharyya D, Barthwal M S, Madan G D S, Chakrabarthy B, Pandey I M, Chopra Meenakshi
Pulmonologist, Army Hospital (Research & Referral), New Delhi, India.
Consultant & Head of Dept of Pulmonology, Army Hospital (Research & Referral), New Delhi, India.
Indian J Tuberc. 2019 Jan;66(1):44-48. doi: 10.1016/j.ijtb.2017.05.007. Epub 2017 Jun 7.
Cough of more than two weeks has become sine quo non with pulmonary tuberculosis (PTB) in a developing country like India. The causes may be different in patients reporting to respiratory OPD vis a vis general OPD.
To study the prevalence of PTB and causes of cough other than PTB among respiratory OPD attendees with cough of more than two weeks duration.
A cross sectional study was carried out over two years in respiratory OPD of a tertiary care chest center of Indian armed forces. Of the 13,004 patients, 505 non HIV PTB suspects were included. Patients with definitive diagnosis of chronic cough were excluded. Efforts were made to establish diagnosis of pulmonary TB using clinical, microbiological and radiological features. However, patients were also subjected to further evaluation (spirometry, bronchoscopy, CECT) based on clinical features, radiological and lab profile to establish definitive diagnosis.
Out of the 505 patients, 10.5% patients had smear positive pulmonary TB, 13.5% smear negative PTB, bronchial asthma (24%), COPD (9.3%), diffuse parenchymal lung diseases (DPLD's) (12.5%), bronchiectasis (6.3%), lung cancer (5.3%) and congestive cardiac failure (4.2%).
Though prevalence of PTB in the study correlated well with the national statistics, but a significant number of patients had other causes of chronic cough, especially, obstructive airway diseases and DPLDs. Thus, there is a need to spread awareness regarding other causes of chronic cough and all efforts should be made to establish alternate diagnosis especially in patients who do not conclusively have PTB.
在印度这样的发展中国家，持续两周以上的咳嗽已成为肺结核（PTB）的必要症状。到呼吸科门诊就诊的患者与到普通门诊就诊的患者病因可能不同。
研究持续咳嗽超过两周的呼吸科门诊患者中肺结核的患病率以及除肺结核外咳嗽的病因。
在印度武装部队一家三级护理胸部中心的呼吸科门诊进行了为期两年的横断面研究。在13004名患者中，纳入了505名非HIV肺结核疑似患者。排除已确诊为慢性咳嗽的患者。努力通过临床、微生物学和放射学特征来确诊肺结核。然而，也根据临床特征、放射学和实验室检查结果对患者进行进一步评估（肺功能测定、支气管镜检查、CT增强扫描）以明确诊断。
在505名患者中，10.5%的患者痰涂片阳性肺结核，13.5%痰涂片阴性肺结核，支气管哮喘（24%），慢性阻塞性肺疾病（9.3%），弥漫性实质性肺疾病（DPLD）（12.5%），支气管扩张（6.3%），肺癌（5.3%）和充血性心力衰竭（4.2%）。
尽管该研究中肺结核的患病率与国家统计数据相关性良好，但相当数量的患者有其他慢性咳嗽病因，尤其是阻塞性气道疾病和弥漫性实质性肺疾病。因此，有必要提高对慢性咳嗽其他病因的认识，并且应尽一切努力进行鉴别诊断，尤其是对于那些不能确诊为肺结核的患者。
