慢性咳嗽患者纤支镜下的气道异常
Airway abnormalities at flexible bronchoscopy in patients with chronic coughKeywords: Bronchoscopy, cough, tracheobronchopathia osteochondroplastica
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 the present authors’ specialist clinic (North West Lung Centre Cough Clinic, Manchester, UK), flexible bronchoscopy is included in the diagnostic work-up of patients with chronic unexplained cough. In a retrospective review, the authors report on their experiences.
Over an 18-month period, patients followed a diagnostic algorithm that included: chest radiography; pulmonary function; methacholine challenge; ear, nose and throat examination; and empirical reflux treatment. Where diagnosis remained elusive, bronchoscopy was performed.
A total of 82 bronchoscopies were carried out for the sole indication of chronic cough. Patient age (mean±SD) was 54.9±11.22 yrs, with a median (range) cough duration of 5 (0.5–30) yrs. In nine (11%) subjects, a diagnosis was made on inspection or biopsy. These included seven cases of tracheobronchopathia osteochondroplastica (TPO), one case of elongated uvula and one case of endobronchial amyloidosis. All TPO patients 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.
慢性咳嗽的程序性诊断提倡对哮喘样症状，鼻后滴漏及胃食管反流疾病的连续性研究和治疗试验，但是气管镜的作用还不清楚。在当前作者的专科诊所（英国，曼彻斯特，西北肺科中心咳嗽诊所），纤维支气管镜被用来不明原因咳嗽患者诊断性病情检查，在一份回顾性研究综述上，作者报道了他们的经验
纤支镜可适用于持续的不明原因咳嗽，可能揭示具有贡献性的病理改变
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