Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report

CHEST Expert Cough Panel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. Methods We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. Results The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Conclusions Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing.

Original languageEnglish (US)
Pages (from-to)1038-1042
Number of pages5
JournalChest
Volume152
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Cough
Immunocompromised Host
Thorax
Immune System
Geographic Locations
HIV Infections
Guidelines

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Cough in Ambulatory Immunocompromised Adults : CHEST Expert Panel Report. / CHEST Expert Cough Panel.

In: Chest, Vol. 152, No. 5, 01.11.2017, p. 1038-1042.

Research output: Contribution to journalArticle

CHEST Expert Cough Panel. / Cough in Ambulatory Immunocompromised Adults : CHEST Expert Panel Report. In: Chest. 2017 ; Vol. 152, No. 5. pp. 1038-1042.
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title = "Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report",
abstract = "Background Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. Methods We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. Results The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Conclusions Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing.",
author = "{CHEST Expert Cough Panel} and Rosen, {Mark J.} and Belinda Ireland and Mangala Narasimhan and Cynthia French and Irwin, {Richard S.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Barker, {Alan F.} and Birring, {Surinder S.} and Fiona Blackhall and Bolser, {Donald C.} and Braman, {Sidney S.} and Christopher Brightling and Priscilla Callahan-Lyon and Chang, {Anne B.} and Andr{\'e}anne Cot{\'e} and Terrie Cowley and Paul Davenport and Satoru Ebihara and {El Solh}, {Ali A.} and Patricio Escalante and Anthony Feinstein and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Peter Gibson and Philip Gold and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Kahrilas, {Peter J.} and Keogh, {Karina A.} and Kefang Lai and Kaiser Lim and {Mark Madison}, J. and Malesker, {Mark A.} and Stuart Mazzone and Alex Molassoitis and {Hassan Murad}, M. and Mangala Narasimhan and Nguyen, {Huong Q.} and Peter Newcombe and Oppenheimer, {John J.} and Restrepo, {Marcos I.} and Mark Rosen and Bruce Rubin and Ryu, {Jay H.} and Jaclyn Smith and Tarlo, {Susan M.} and Julie Turmel",
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T1 - Cough in Ambulatory Immunocompromised Adults

T2 - CHEST Expert Panel Report

AU - CHEST Expert Cough Panel

AU - Rosen, Mark J.

AU - Ireland, Belinda

AU - Narasimhan, Mangala

AU - French, Cynthia

AU - Irwin, Richard S.

AU - Adams, Todd M.

AU - Altman, Kenneth W.

AU - Barker, Alan F.

AU - Birring, Surinder S.

AU - Blackhall, Fiona

AU - Bolser, Donald C.

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Chang, Anne B.

AU - Coté, Andréanne

AU - Cowley, Terrie

AU - Davenport, Paul

AU - Ebihara, Satoru

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Feinstein, Anthony

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Gibson, Peter

AU - Gold, Philip

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kahrilas, Peter J.

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lim, Kaiser

AU - Mark Madison, J.

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - Molassoitis, Alex

AU - Hassan Murad, M.

AU - Narasimhan, Mangala

AU - Nguyen, Huong Q.

AU - Newcombe, Peter

AU - Oppenheimer, John J.

AU - Restrepo, Marcos I.

AU - Rosen, Mark

AU - Rubin, Bruce

AU - Ryu, Jay H.

AU - Smith, Jaclyn

AU - Tarlo, Susan M.

AU - Turmel, Julie

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. Methods We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. Results The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Conclusions Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing.

AB - Background Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. Methods We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. Results The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Conclusions Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing.

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