Yu Li, Xu Xianghuai, Niu Shanshan
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
J Thorac Dis. 2020 Sep;12(9):5238-5242. doi: 10.21037/jtd-2020-icc-001.
Chronic cough is a common symptom of many diseases. Guidelines on cough from different countries recommend chest X-ray as the first-line examination. However, as compared to computerized tomography (CT), chest X-ray is insensitive in the diagnosis of many diseases. We speculate that CT is more helpful in excluding the causes of long-term cough, such as bronchial tumors and pulmonary interstitial diseases, which prevents patients from receiving unnecessary examinations and diagnostic treatments for chronic cough. In addition, a single chest CT is safe and affordable in some regions. Therefore, chest CT may be recommended as a first-line examination for patients with chronic cough. In addition, although bronchoscopy is employed as a further examination for chronic cough, it plays an important role in the diagnosis of chronic cough, especially in rare bronchial diseases such as amyloidosis and foreign body inhalation. Induced sputum cytology was not accepted as a necessary examination for chronic cough, but it becomes a first-line examination until physicians recognize that non-asthmatic eosinophilic bronchitis is a common cause of chronic cough. Therefore, we speculate that the roles of chest CT and bronchoscopy in the identification of causes of chronic cough are increasingly important; in some regions, or for patients suspicious for uncommon causes of chronic cough, CT and bronchoscopy are recommended as first-line examinations.
慢性咳嗽是许多疾病的常见症状。不同国家的咳嗽指南推荐胸部X线作为一线检查。然而，与计算机断层扫描（CT）相比，胸部X线在许多疾病的诊断中不够敏感。我们推测CT在排除长期咳嗽的病因方面更有帮助，如支气管肿瘤和肺间质疾病，这可避免患者接受不必要的慢性咳嗽检查和诊断性治疗。此外，在某些地区，单次胸部CT检查安全且费用可承受。因此，胸部CT可推荐作为慢性咳嗽患者的一线检查。此外，虽然支气管镜检查用于慢性咳嗽的进一步检查，但它在慢性咳嗽的诊断中起着重要作用，尤其是在罕见的支气管疾病如淀粉样变性和异物吸入方面。诱导痰细胞学检查曾不被认为是慢性咳嗽的必要检查，但在医生认识到非哮喘性嗜酸性粒细胞性支气管炎是慢性咳嗽的常见病因之前，它已成为一线检查。因此，我们推测胸部CT和支气管镜检查在确定慢性咳嗽病因方面的作用越来越重要；在某些地区，或对于怀疑有不常见慢性咳嗽病因的患者，推荐CT和支气管镜检查作为一线检查。
