Should computed tomography and bronchoscopy be routine examinations for chronic cough?

Abstract

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.

Diagnostic yield of chest radiograph in management of adults with difficult-to-treat chronic cough—retrospective study

“…A few other authors share similar opinion. Li et al, states that as the role of chest CT in the identification of causes of CC is increasing CT may be recommended even as the first-line examination (23). Taking into consideration scarcity of these studies, we believe our findings add to the existing debate on the diagnostic role of imaging studies in adults with CC.…”

“…Considering role of chest CT in the diagnostics of adults with CC, we should balance profit and loss. Although there is a dispute about the cancerogenic effect of low doses of ionizing radiation (35,40,41), we believe it should not be a final argument against chest CT in diagnosing adults with CC (23,42,43). However, considering the low cost-effectiveness and radiation exposure of thoracic CT scanning in diagnosis of CC (5,14), there is certainly a need to define a group of patients which can particularly benefit from referral to CT. As in our study false negative CXR results were more common in patients older than 62 years, it seems that chest CT should be considered particularly in this group of patients.…”

Chest computed tomography scan utilization and diagnostic outcomes in chronic cough patients with normal chest X-rays: analysis of routinely collected data of a tertiary academic hospital

“…The European Respiratory Society (ERS) cough guideline task force developed a conditional recommendation against routine chest CT scans in chronic cough patients with normal chest X-rays and physical examination (8). However, the level of supporting evidence was very low (8), and to date, the number and sample size of relevant studies remains small (12)(13)(14).…”