Wingfield Digby James, King Jenny, Al-Sheklly Bashar, Marsden Paul, Fowler Steve, Smith Jaclyn
School 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.
School 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.
Respir Med. 2023 Oct;217:107335. doi: 10.1016/j.rmed.2023.107335. Epub 2023 Jul 17.
Refractory/unexplained cough (RUCC) is typically associated with throat symptoms and a dry cough. Some patients attending specialist cough clinics however, report sputum production (>1 tablespoon daily) and atypical sensations (urge-to-cough in chest). Bronchoscopy findings in this specific cohort have rarely been described.
We aimed to evaluate bronchoscopy, bronchoalveolar lavage (BAL) cell differential and microbiology findings in RUCC with mucus production.
We retrospectively reviewed case notes, procedure results and treatment of patients undergoing bronchoscopy for RUCC with more than a tablespoon of sputum daily.
Data were included from 54 patients with RUCC, normal or trivial findings on CT (Computerised Tomography) imaging and no response to guideline-directed treatment of their cough. Most (84%) patients had BAL neutrophilia and excessive dynamic airway collapse (EDAC) was seen in 31%. Treatment strategies in these patients differed to those adopted in typical RUCC associated with a dry cough. Management was influenced or changed in 48/54 (89%) of the patients undergoing bronchoscopy.
Bronchoscopy provides high diagnostic value in RUCC with mucus production (>1 tbsp daily), identifying specific treatable traits including neutrophilic airway inflammation and EDAC.
难治性/不明原因咳嗽（RUCC）通常与咽喉症状及干咳相关。然而，一些前往咳嗽专科门诊就诊的患者报告有痰液生成（每日超过1汤匙）及非典型感觉（胸部咳嗽冲动）。这一特定队列的支气管镜检查结果鲜有描述。
我们旨在评估有痰液生成的RUCC患者的支气管镜检查、支气管肺泡灌洗（BAL）细胞分类及微生物学检查结果。
我们回顾性分析了每日咳痰超过1汤匙的因RUCC接受支气管镜检查患者的病历、检查结果及治疗情况。
纳入了54例RUCC患者的数据，这些患者CT（计算机断层扫描）成像正常或仅有轻微异常，且对咳嗽的指南导向治疗无反应。大多数（84%）患者BAL中性粒细胞增多，31%可见过度动态气道塌陷（EDAC）。这些患者的治疗策略与典型干咳相关的RUCC患者不同。48/54（89%）接受支气管镜检查的患者的治疗受到影响或发生改变。
支气管镜检查对有痰液生成（每日>1汤匙）的RUCC具有较高的诊断价值，可识别包括中性粒细胞性气道炎症和EDAC在内的特定可治疗特征。
