The clinical utility of flexible bronchoscopy in the evaluation of chronic cough

Study objectives: To assess the clinical utility of flexible bronchoscopy (FB) in the evaluation of patients with chronic cough and normal or nonlocalizing chest radiographic findings. Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Forty-eight patients with chronic cough and no other clinical or radiographic indications for FB who underwent the procedure from 1996 to 2001. Results: Before FB, 45 patients had a chest radiograph and 21 patients had a chest CT performed. On visual inspection, 37 of 48 of the FB findings (82%) were normal, 9 were consistent with "bronchitis," one patient had a "small tracheal plaque," and one patient had "minimal arytentoid redundancy." Three of the 27 patients who had a microbiologic assessment performed during their FB demonstrated potentially pathogenic organisms. Antibiotic treatment based on culture data did not result in improvement in cough. Cytologic examination was performed in specimens from 33 patients; 1 patient was noted to have reactive squamous atypia, and the remainder were normal. The patient noted to have minimal arytenoid redundancy and the patient with a tracheal plaque each had another etiology for their cough identified, the treatment of which resulted in cough improvement. Conclusions: FB adds little to the diagnosis of chronic cough in the context of normal or nonlocalizing chest radiographic or CT findings. FB did not result in successful treatment alteration, nor did it contribute to the identification of the cough etiology.