Airway abnormalities at flexible bronchoscopy in patients with chronic cough

¹ University of Manchester and North West Lung Centre, South Manchester University Hospitals Trust, Manchester, UK
² Dept of Radiology, South Manchester University Hospitals Trust, Manchester, UK
³ Dept of Histopathology, South Manchester University Hospitals Trust, Manchester, UK

^* To whom correspondence should be addressed. E-mail: samdecalmer{at}hotmail.com.

	Abstract

The algorithms utilised in the diagnosis of chronic cough advocate sequential investigations and treatment trials for asthma-like syndromes, post nasal drip and gastro-oesophageal reflux disease, however the role of bronchoscopy is unclear. In our specialist clinic, flexible bronchoscopy is included in the diagnostic workup of patients with chronic unexplained cough. We report on our experiences in a retrospective review.

Over an 18 month period patients followed a diagnostic algorithm which included chest x-ray, pulmonary function, methacholine challenge, ENT examination and empirical reflux treatment. If diagnosis remained elusive, bronchoscopy was performed.

82 bronchoscopies were carried out for the sole indication of chronic cough. Mean patient age was 54.9 years (±11.22) with median cough duration of 5 years (range 0.5–30). In 9 (11%) subjects, a diagnosis was made on inspection or biopsy. These included Tracheobronchopathia Osteochondroplastica (TPO) (7), elongated uvula (1) and endobronchial amyloidosis (1). TPO patients all had early changes, with a typical nodular appearance to the tracheal cartilage, without significant airway obstruction. These subtle changes could not have been predicted from less invasive procedures and would have been missed without bronchoscopy.

Flexible bronchoscopy is indicated in persistent unexplained cough and may reveal contributing pathology.