CHEST Guidelines-Cough-in-Ambulatory-Immunocompromised-Adults_2017

Cough-in-Ambulatory-Immunocompromised-Adults_2017_

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The CHEST Expert Panel Report addresses the diagnostic challenge of cough in ambulatory immunocompromised adults with normal chest radiographs. Cough is a common reason for seeking medical care, and its causes might differ between immunocompromised and immunocompetent individuals. The panel conducted a systematic review to determine common causes of cough in adults with immune deficiencies, such as those with hematologic malignancies, solid tumors, immunosuppressive therapy, or HIV infection, who show normal chest radiographs.<br /><br />The review revealed no high-quality evidence to guide clinicians on whether the diagnostic approach for cough in immunocompromised patients should differ from that for immunocompetent individuals. Consequently, suggestions were developed through consensus rather than concrete evidence. The panel advises that the initial diagnostic algorithm should mirror that used for immunocompetent patients but should consider the type and severity of immune defects, geographic location, and social determinants. Special attention is recommended for tuberculosis in areas with high prevalence, particularly among HIV-positive individuals.<br /><br />The 2006 CHEST Cough Guidelines are modified to include tuberculosis as a consideration in initial evaluations for specific patient populations, regardless of radiographic findings. It is suggested that evaluations for specific diseases related to underlying immune disorders be carried out if common causes of cough are excluded.<br /><br />The panel calls for further studies to close gaps in knowledge, suggesting prospective studies to explore the spectrum and frequency of cough causes in immunocompromised adults and the development of optimal diagnostic algorithms. The consensus from this panel provides preliminary guidance in the absence of high-quality evidence, with the recommendation to reassess common and opportunistic diagnoses in the context of immune deficiencies.

Keywords

cough

immunocompromised

diagnostic challenge

CHEST Expert Panel

immune deficiencies

tuberculosis

HIV infection

diagnostic algorithm

systematic review

hematologic malignancies