Impact of chest computed tomography scan on the management of patients with chronic cough

• Published in: ERJ open research 2021-07, Vol.7 (3), p.222-2021
• Main Authors: Descazeaux, Mathilde, Brouquières, Danièle, Didier, Alain, Lescouzères, Marianne, Napoléon, Marie-Françoise, Escamilla, Roger, Guilleminault, Laurent
• Format: Article
• Language: English
• Subjects: Human health and pathology; Infectious diseases; Life Sciences; Research Letters
• ISSN: 2312-0541; 2312-0541
• DOI: 10.1183/23120541.00222-2021

Chronic cough (CC), defined as cough lasting for more than 8 weeks, is a common reason for consultation in general and respiratory medicine. CC is a complex entity with potential multiple causes. CC management has been described in American and European guidelines [1, 2]. Lung function tests and chest radiography are mandatory as first-line diagnostic work-up in CC. However, the usefulness of chest computed tomography (CT) in CC management has not been clearly identified. According to European guidelines, clinicians should not routinely perform a chest CT scan in CC patients presenting normal chest radiography and physical examination [1]. On the other hand, considering the American guidelines, a chest CT scan has to be taken into account in patients with normal chest radiography and after ruling out common causes of CC [2]. However, no criteria regarding chest CT scan in CC patients have been clearly established. In order to provide data on chest CT scans in CC management, our study aims to determine the impact of chest CT scans on the management of patients with CC. A retrospective observational study was carried out in the Department of Respiratory Medicine at Toulouse University Hospital Center for Research from 2002 to 2018. Inclusion criteria were: 1) patients aged of 16 years old or older; 2) CC was the main reason for the consultation; 3) both normal chest radiography and physical examination of the lungs; and 4) chest CT scan was performed as an investigation of CC. Exclusion criteria were: 1) no smoking cessation or no discontinuation of drugs causing drug-induced cough within the past 4 weeks prior the inclusion; and 2) underlying conditions associated with a history of abnormal CT scan. Patients' characteristics have been previously published [3]. Productive cough was defined as cough with production of more than 100 mL of sputum per day. Consequently, dry cough was defined as no production of sputum over the 100 mL per day threshold. The use of patients' medical data was approved by the Institutional Review Board of the French Society for Respiratory Medicine (CEPRO 2018-036). CC patients were divided into two groups according to normal or abnormal chest CT scan. Abnormalities were determined according to an established consensus by two clinicians blinded to clinical and functional data. The Fleischner Society glossary was used for the definition of normal chest radiography and chest CT scan [4]. A nodule was considered benign if a biopsy rule