TY - JOUR T1 - Bronchoscopy and laryngoscopy findings in refractory chronic cough (RCC) JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2021.PA1936 VL - 58 IS - suppl 65 SP - PA1936 AU - James Wingfield Digby AU - Jenny King AU - Jacky Smith AU - Jemma Haines AU - Sarah Hennessey AU - Siobhan Ludlow AU - Paul Marsden Y1 - 2021/09/05 UR - http://erj.ersjournals.com/content/58/suppl_65/PA1936.abstract N2 - Background: A significant proportion of patients referred to our tertiary cough clinic have a poorly described phenotype, displaying symptoms of cough hypersensitivity and expectoration of sputum. We aimed to establish the diagnostic yield of joint laryngoscopy and bronchoscopy in this group.Methods: We retrospectively reviewed results from 80 patients with RCC, undergoing a bronchoscopy and laryngoscopy (January 2019 to December 2020).Results: Bronchoscopy was requested to investigate symptoms and guide management in all cases. 43/80 patients had symptoms of cough hypersensitivity and sputum production (≥tsp to egg-cup full daily). Urge to cough came from the throat (52%), chest (30%) or both chest and throat (18 %). Positive macroscopic findings were seen in 42.5%, which included tracheopathia osteochondroplastica (5/80), airway collapsibility 27/80 and tracheobronchomalacia (1/80). Eosinophilic bronchitis (Eos >1 %) was seen in 6% of cases and neutrophilia (>3%) was seen in 88% of patients. Mean cell counts in 68 patients undergoing BAL were eosinophils 0.28% +/- 0.85, lymphocytes 11.75 % +/-9.7, neutrophils 18% +/-14.95 and macrophages 50% +/-16.2. Bacterial growth was detected in 7% of cases. Laryngoscopy showed inducible laryngeal obstruction or sensitivity in 35% and other upper airway findings in 18% (mucus, inflammation, nasal polyps). Findings influenced management choices; Azithromycin (10/80), hypertonic saline and chest physio (13/80), speech and language therapy (14/80) and anti-tussives (18/80) were initiated post procedure.Conclusion: Our data supports the value of bronchoscopy and laryngoscopy in RCC, especially in individuals with productive cough and features of cough hypersensitivity.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA1936.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -