ObjectiveTo systematically evaluate the risk factors for persistent cough after lung resection, providing a theoretical basis for preventing persistent postoperative cough. MethodsThe Cochrane Library, Web of Science, EMbase, PubMed, Chinese Biomedical Literature Database, Wanfang, CNKI, and VIP databases were searched for studies related to risk factors for persistent cough after lung resection. The search period was from database inception to March 30, 2023. Two researchers independently screened the literature, extracted data, and performed quality assessment. RevMan 5.3 software was used for meta-analysis. ResultsA total of 17 articles with 3 698 patients were included. Meta-analysis results showed that females [OR=3.10, 95%CI (1.99, 4.81), P<0.001], age [OR=1.72, 95%CI (1.33, 2.21), P<0.001], right-sided lung surgery [OR=2.36, 95%CI (1.80, 3.10), P<0.001], lobectomy [OR=3.40, 95%CI (2.47, 4.68), P<0.001], upper lobectomy [OR=8.19, 95%CI (3.87, 17.36), P<0.001], lymph node dissection [OR=3.59, 95%CI (2.72, 4.72), P<0.001], bronchial stump closure method [OR=5.19, 95%CI (1.79, 16.07), P=0.002], and postoperative gastric acid reflux [OR=6.24, 95%CI (3.27, 11.91), P<0.001] were risk factors for persistent cough after lung resection, while smoking history was a protective factor against postoperative cough [OR=0.59, 95%CI (0.45, 0.77), P<0.001]. In addition, the quality of life score of patients with postoperative cough decreased compared with that before surgery [MD=1.50, 95%CI (0.14, 2.86), P=0.03]. ConclusionCurrent evidence suggests that females, age, right-sided lung surgery, lobectomy, upper lobectomy, lymph node dissection, bronchial stump closure method (stapler closure), and postoperative gastric acid reflux are independent risk factors for persistent postoperative cough in lung resection patients, while smoking history may be a protective factor against postoperative cough. This provides evidence-based information for clinical medical staff on how to prevent and reduce persistent postoperative cough in patients and improve their quality of life in the future.
Objective To explore the factors of postoperative cough in lung cancer patients. Methods Totally 130 lung cancer patients of single medical team (average age of 58.75±9.34 years, 65 males and 65 females), from February 2016 to February 2017 in the Department of Thoracic Surgery of West China Hospital of Sichuan University, were investigated by Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC). We analyzed and calculated the preoperative and postoperative scores of LCQ-MC, Cronbach α and the influencing factor. Results The preoperative score of LCQ-MC's physiological dimension was significantly lower in the postoperative cough group (6.30±0.76) than that of the postoperative non-cough group (6.56±0.60,P=0.044), while the preoperative total score of LCQ-MC (19.53±1.78, 20.03±1.45) was not statistically different (P=0.080). The postoperative score of LCQ-MC was significantly lower in the postoperative cough group (17.32±2.79) than that of the postoperative non-cough group (19.70±1.39,P<0.001). And the scores of physiological, psychological and social dimension were significantly lower in the postoperative cough group (5.32 ±1.14, 5.73±1.14, 6.23±0.89) than those of the postoperative non-cough group (6.25±0.63, 6.67±0.54, 6.78±0.49) (P values were all less than 0.001). The result of multi-factor logistic regression analysis showed the condition of preoperative cough symptom (OR=0.354, 95%CI=0.126–0.994, P=0.049) and anesthesia time (OR=1.021, 95% CI=1.003–1.040, P=0.021) were the risk factors. Conclusion The risk factors of postoperative cough symptoms in lung cancer patients are the condition of preoperative cough symptoms and anesthesia time.
Objective To explore the association between cough patterns and cerebrovascular disease risk, and to provide epidemiological evidence for the early diagnosis and prevention of cerebrovascular disease. Methods During the period from 2010 to 2012 in Guizhou Province, a multi-stage proportional stratified cluster sampling method was used to recruit people with the inclusion criteria of the study into a cohort and a baseline questionnaire for demographic information, lifestyle, and disease history was administered. The incidence of cerebrovascular disease was followed up from 2016 to 2020. Results A total of 4804 subjects were followed up, and 4589 (53.5% were female) subjects were enrolled in final investigation. Compared with non-chronic cough group, there was no statistical significance in the risk of cerebrovascular diseases (P>0.05), however, chronic cough (the risk ratio was 2.00 and the 95% confidence interval ranged from 1.08 to 3.69) was twice as likely to develop cerebrovascular disease as non-cough. Conclusions People with chronic cough are more likely to develop cerebrovascular disease than people without cough. More attention to the management and control of cough should be paid to avoid chronic cough, so as to reduce the risk of cerebrovascular diseases.
Objective Using a simple management strategy to investigate the etiologic spectrum of chronic cough in Chengdu city and its suburbs. Methods Chronic cough patients were randomly recruited fromthe outpatient clinic of Sichuan Provincial People ’s Hospital between July 2011 to May 2012. A conception of “Chronic Airway Inflammatory Cough Syndrome, CAICS”was established including several common causes of cough such as cough variant asthma ( CVA) , eosinophilic bronchitis ( EB) , atopic cough ( AC) , and atypical chronic bronchitis. Based on CAICS, a simplified suspected diagnosis procedure of chronic cough was conducted. Patients were empirically treated. Etiology and efficiency of chronic cough was analyzed. Results A total of 148 patients of chronic cough were recruited. The mean age was ( 43. 0 ±13. 0) years old. There were 72 male and 76 female patients with mean ages of ( 39. 7 ±10. 7) and ( 45. 0 ± 14. 2) years old respectively. The males were younger than the females ( P lt; 0. 05) . There was 96. 6% ( 143/148) of patients suspectedly diagnosed and 3.4% ( 5/148) patients were undiagnosed. The suspected causes of these chronic cough patients were as follows, ie. CAICS ( 57. 5% ) , upper airway cough syndrome ( UACS, 21. 5%) , gastroesophageal reflux cough ( GERC, 9. 1% ) , and others ( 8. 4% ) . A single possible cause was found in 95 patients ( 64.1% ) , two possible causes in 41 patients ( 27. 7% ) , and three possible causes in 3 patients( 2. 0% ) . 12.2% of chronic cough patients were combined with allergic rhinitis ( AR) . Among the diseases, CVA, CAICS and UACS were disposed to coexist with AR. The overall efficiency of empiric management strategy of chronic cough was 83. 7% .Conclusions The etiological spectrum of chronic cough in Chengdu acquired by this strategy was generally consistent with previous findings in China.The three most important causes of chronic cough in Chengdu were CAICS, UACS and GERC. This strategy was simple, effective, economic and feasible. It could be a primary management for chronic cough in some hospital.
ObjectiveTo evaluates the values of fractional exhaled nitric oxide (FENO) in the treatment of chronic cough prospectively.MethodsSubjects with chronic cough were recruited from the outpatient clinic of China-Japan Friendship Hospital. All the patients accepted FENO tests, sputum cell counts, pulmonary function tests, bronchial provocation tests, serum IgE, cough symptom scores and Leicester Cough Questionnaire before and after treatment of 4 weeks.ResultsThere were 29 patients with cough variant asthma (CVA), 19 patients with eosinophilic bronchitis (EB) and 39 patients with other causes. The baseline FENO level of the subjects whose coughs were relieved after inhaled corticosteroids (ICS) therapy of 4 weeks was (63±42) ppb, significantly higher than those with bad-response [(28±13) ppb, P<0.01]. The proportion of FENO decrease after ICS therapy was not only significantly related to the proportion of eosinophilic decrease (r=0.54, P<0.01), but also significantly related to the proportion of decrease of cough symptom scores (r=0.48, P<0.01). To distinguish the good responders from bad responders, the optimal baseline FENO cutoff value was 36 ppb, with sensitivity of 82%, specificity of 93%, positive predictive value of 94%, negative predictive value of 87%, accuracy of 83%.ConclusionsThere is a good relationship between the FENO decreasing levels after ICS therapy and the reliefs of cough symptoms in the CVA and EB patients. Chronic cough patients with FENO value more than 36 ppb are indicated to respond to ICS therapy.
ObjectiveTo explore the spectrum and frequency of respiratory symptoms in outpatients clinics.MethodsPatients were enrolled from outpatient clinic of Guangzhou Institute of Respiratory Disease. Information about respiratory symptoms especially cough was obtained from the survey questionnaire from July 2013 to August 2013 .ResultsA total of 900 were eligible out of 939 questionnaires. The mean age of the patients was (48.9±18.3) years, 453 (50.3%) were males, 447 (49.7%) were females. The cases of cough, wheeze, polypnea, chest distress, pharyngalgia, catarrh, chest pain, throat itching, fever, hemoptysis and other symptom was 687 (76.3%), 310 (34.4%), 307 (34.1%), 173 (19.2%), 107 (11.9%), 101 (11.2%), 82 (9.1%), 59 (6.6%), 36 (4.0%), 10 (1.1%) and 129 (14.3%) out of the patients, respectively. In patients with cough, 69.5% of them considered cough as their predominant symptom, and 22.1% of them reported that cough was the only symptom. 56.3% of cases were chronic cough, while acute and subacute cough accounted for 29.7% and 14.0%, separately. The proportion of female in acute cough was significantly higher than that of males (60.3%vs. 39.7%, P<0.01).ConclusionsCough, especially the chronic cough is the most common reason for patients who seeking health care in outpatient clinic of respirologist. There are more females suffered from acute cough than males.
Objective To compare the clinical characteristics of chronic cough, and to establish the Modified Cough Assessment Test and the simple decision tree to improve the efficacy of etiologic diagnosis. Methods Patients with chronic cough consulted in Tongji Hospital between October 2021 and August 2023 were enrolled in our study. The patients with identified single cause were divided into 3 groups accordingly: corticosteroid-responsive cough (CRC), upper airway cough syndrome (UACS) and gastroesophageal reflux-related cough (GERC). And the characteristics of chronic cough in different causes were assessed and compared by cough questionnaires. Independent predictors of various causes were identified by multivariate logistic regression analysis and used to establish the Modified Cough Assessment Test (MCET) and to construct the simple decision tree. Results A total of 358 patients were enrolled, including 201 with CRC (56.1%), 125 with UACS (34.9%) and 32 with GERC (8.94%). "Cough with wheezing or chest tightness" (OR=3.222, 95%CI 2.144 - 4.843, P<0.001), "Cough with daytime heaviness and nighttime lightness" (OR=1.755, 95%CI 1.264 - 2.435, P<0.001), and "Cough with acid reflux, heartburn or indigestion" (OR=15.580, 95%CI 5.894 - 41.184, P<0.001) were independent factors for each group, respectively. The area under ROC curve for classification of CRC, UACS and GERC were 0.871, 0.840 and 0.988 for MCET, which were better than those of Leicester Cough Questionnaire (LCQ) (0.792, 0.766 and 0.913) and Cough Evaluation Test (CET) (0.649, 0.691 and 0.580). The accuracy of the simple decision tree for the differential diagnosis of chronic cough was 77.4%. Conclusion The simple decision tree based on the Modified Cough Evaluation Test is a simple and effective method of etiologic diagnosis of chronic cough, which can be used as a tool to improve the efficacy of clinical diagnosis in outpatient settings.
Objective To analyze the risk factors for chronic cough following pulmonary surgery in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on 427 NSCLC patients who underwent pulmonary surgery in the Department of Thoracic Surgery, The First Affiliated Hospital of the University of Science and Technology of China, between January 2021 and June 2023. Patients were categorized into a chronic cough group (103 patients) and a non-chronic cough group (324 patients) based on the presence of cough at 8 weeks post-surgery. A comparative analysis was performed between the two groups, considering gender, age, smoking history, comorbidities, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration. Factors showing statistical significance in univariate analysis underwent multivariate logistic regression analysis. Results Among the 427 patients undergoing pulmonary surgery, there were 165 males and 262 females, with an average age of (59.93±12.11) years. The incidence of chronic cough was 24.12%. Univariate analysis revealed significant differences in smoking history, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration ≥135.5 minutes, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration (P<0.05). Multivariate logistic regression analysis indicated that the surgical site (right upper lung), operative techniques (lobectomy), lymph node dissection, and anesthesia time ≥135.5 minutes were independent risk factors for chronic cough following pulmonary surgery. ConclusionPatients undergoing right upper lung surgery, lobectomy, lymph node dissection, and experiencing anesthesia duration ≥135.5 minutes are at a higher risk of developing chronic cough post-pulmonary surgery.
Cough recognition provides important clinical information for the treatment of many respiratory diseases. A new Mel frequency cepstrum coefficient (MFCC) extracting method has been proposed on the basis of the distributional characteristics of cough spectrum. The whole frequency band was divided into several sub-bands, and the energy coefficient for each band was obtained by method of principle component analysis. Then non-uniform filter-bank in Mel frequency is designed to improve the extracting process of MFCC by distributing filters according to the spectrum energy coefficients. Cough recognition experiment using hidden Markov model was carried out, and the results showed that the proposed method could effectively improve the performance of cough recognition.
In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.