Chest
Volume 140, Issue 2, August 2011, Pages 317-323
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Original Research
Signs and Symptoms of Chest Diseases
Bronchoscopic and High-Resolution CT Scan Findings in Children With Chronic Wet Cough

https://doi.org/10.1378/chest.10-3050Get rights and content

Background

Chronic wet cough strongly suggests endobronchial infection, which, if left untreated, may progress to established bronchiectasis. Our aim was to compare the effectiveness of chest high-resolution CT (HRCT) scanning and flexible bronchoscopy (FB) in detecting airway abnormalities in children with chronic wet cough and to explore the association between radiologic and bronchoscopic/BAL findings.

Methods

We retrospectively evaluated a selected population of 93 children (0.6-16.4 years) with wet cough for > 6 weeks who were referred to a specialized center and deemed unlikely to have asthma. All patients were submitted to hematologic investigations, chest radiographs (CXRs), HRCT scanning, and FB/BAL. HRCT scans were scored with the Bhalla method, and bronchoscopic findings of bronchitis were grouped into five grades of severity.

Results

Positive HRCT scan findings were present in 70 (75.2%) patients (P = .76). A positive correlation was found between Bhalla score and duration of cough (ρ = 0.23, P = .028). FB/BAL was superior to HRCT scan in detecting abnormalities (P < .001). The Bhalla score correlated positively with type III (OR, 5.44; 95% CI, 1.92-15.40; P = .001) and type IV (OR, 8.91; 95% CI, 2.53-15.42; P = .001) bronchoscopic lesions; it also correlated positively with the percentage of neutrophils in the BAL (ρ = 0.23, P = .036).

Conclusions

HRCT scanning detected airway wall thickening and bronchiectasis, and the severity of the findings correlated positively with the length of clinical symptoms and the intensity of neutrophilic inflammation in the airways. However, HRCT scanning was less sensitive than FB/BAL in detecting airway abnormalities. The two modalities should be considered complementary in the evaluation of prolonged wet cough.

Section snippets

Study Population and Protocol

We retrospectively evaluated all children referred for chronic wet cough to the Allergy-Pneumonology Department of Penteli Children's Hospital from May 1996 through February 2010. Chronic wet cough was defined as a moist- or wet-sounding cough that occurred almost daily for > 6 weeks without improvement. Characterization of cough quality was based on parental report and was corroborated by a physician during the clinic visit. Wheeze, when present, was also confirmed by a physician. Atopy was

Results

The medical charts of 102 children who underwent HRCT scan, underwent FB, and fulfilled the inclusion criteria were reviewed for the purpose of this study. Ninety-three patients (age range 0.6-16.4 years) had complete clinical, radiographic, and bronchoscopic data and composed the study population. The patient characteristics are shown in Table 1. Thirty-two children (34.4%) had cough for > 6 weeks but < 3 months, 20 (21.5%) for > 3 months but < 1 year, and 41 (44.1%) for > 1 year. The presence

Discussion

This study of a selected childhood population referred to a specialized center for chronic wet cough, which was not deemed to be due to asthma, showed that the severity of the radiologic findings on HRCT scan correlates positively with the duration of wet cough and with the intensity of the neutrophilic inflammation in the airways. More importantly, FB with BAL proved more sensitive than HRCT scan in detecting airway pathology in these children, whereas high radiologic scores are associated

Acknowledgments

Author contributions: Dr Douros: contributed to evaluation of flexible bronchoscopy videos, analyzing the data, and drafting the manuscript, and contributed to and approved the final manuscript.

Dr Alexopoulou: contributed to evaluating chest radiographs and high-resolution CT scans and contributed to and approved the final manuscript.

Dr Nicopoulou: contributed to collecting the data and contributed to and approved the final manuscript.

Dr Anthracopoulos: contributed to designing the study,

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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