Nevertheless, in the setting of elevated risk (ie, smoking and occupational exposure), the prevalence may be more significant. The role of chest radiography in the early evaluation of patients with chronic cough is largely founded in the exclusion of treatable and/or serious underlying pulmonary pathology. When extrapolating from the available evidence, there remains a question regarding the sensitivity of chest radiography for the detection of subclinical disease and early malignancy. In this setting, there may be a population of patients with chronic cough that may benefit from earlier use of advanced imaging. Future research into this topic may elucidate the specific features and clinical qualities that would provide risk stratification and entail appropriate imaging recommendation. CT Chest There is no relevant literature to support the use of chest CT in patients with chronic cough who have one or more high-risk factors for lung cancer. In nonsmoking adults, risk factors vary and include environmental pollutants, genetic variations, underlying chronic pulmonary disease, immunosuppression, and occupational exposures (ie, asbestos and silica) [52]. Cough has been shown to be a prevalent symptom in patients with lung cancer [49,50], 57% of a small cohort of consecutive patients with lung cancer (n = 223). However, the true prevalence of isolated cough (without any additional clinical features) in the setting of malignancy remains unknown. Some authors suggest this combination to be rare in the clinical setting of chronic cough [16]. In a retrospective analysis of patients with chronic cough who have normal chest radiographs, 2 out of 266 diagnoses were determined to be malignancy. Both patients had suspicious clinical findings, which prompted further evaluation with chest CT. It is also worth noting that both patients had a normal chest radiograph [16].
Chronic Cough. Nevertheless, in the setting of elevated risk (ie, smoking and occupational exposure), the prevalence may be more significant. The role of chest radiography in the early evaluation of patients with chronic cough is largely founded in the exclusion of treatable and/or serious underlying pulmonary pathology. When extrapolating from the available evidence, there remains a question regarding the sensitivity of chest radiography for the detection of subclinical disease and early malignancy. In this setting, there may be a population of patients with chronic cough that may benefit from earlier use of advanced imaging. Future research into this topic may elucidate the specific features and clinical qualities that would provide risk stratification and entail appropriate imaging recommendation. CT Chest There is no relevant literature to support the use of chest CT in patients with chronic cough who have one or more high-risk factors for lung cancer. In nonsmoking adults, risk factors vary and include environmental pollutants, genetic variations, underlying chronic pulmonary disease, immunosuppression, and occupational exposures (ie, asbestos and silica) [52]. Cough has been shown to be a prevalent symptom in patients with lung cancer [49,50], 57% of a small cohort of consecutive patients with lung cancer (n = 223). However, the true prevalence of isolated cough (without any additional clinical features) in the setting of malignancy remains unknown. Some authors suggest this combination to be rare in the clinical setting of chronic cough [16]. In a retrospective analysis of patients with chronic cough who have normal chest radiographs, 2 out of 266 diagnoses were determined to be malignancy. Both patients had suspicious clinical findings, which prompted further evaluation with chest CT. It is also worth noting that both patients had a normal chest radiograph [16].