CHEST Guidelines-Cough in Ambulatory Immunocompromised Adults

Cough in Ambulatory Immunocompromised Adults

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The CHEST Expert Panel Report addresses the challenge of diagnosing and managing cough in immunocompromised adults who have normal chest radiographs. This report acknowledges that cough is a frequent reason for medical consultation and explores how its causes in immunocompromised patients might differ from those in immunocompetent individuals. <br /><br />A systematic review was conducted by the CHEST Expert Cough Panel but yielded no high-quality evidence to definitively guide clinicians on the causes of cough specific to immunocompromised patients with normal radiographic findings. Consequently, the panel developed suggestions based on a consensus approach, emphasizing that the initial diagnostic algorithm should mirror the evaluations used for immunocompetent patients while considering the type and severity of immune deficiency, geographic location, and social factors. <br /><br />Furthermore, the panel suggests including tuberculosis in the initial evaluation for immunocompromised patients residing in high TB-prevalence areas, irrespective of radiographic findings. The report notes that certain opportunistic infections, although not immediately evident on normal radiographs, may be common due to the limited sensitivity of radiographs in detecting such infections when the immune response is weakened.<br /><br />The panel emphasizes considering non-infectious causes of cough and specific immune disorder-related diseases if general diagnoses are excluded. As a future endeavor, the report encourages conducting prospective studies to fill knowledge gaps regarding the spectrum and frequency of cough causes, the influence of varying immune defects, and devising optimal diagnostic algorithms for this patient group.<br /><br />In summary, while the report does not amend the recommended practice significantly from that for immunocompetent individuals, it urges consideration of specific opportunistic infections and individual patient context, particularly in high-risk geographical regions.

Keywords

immunocompromised

cough

diagnosis

CHEST Expert Panel

normal chest radiographs

opportunistic infections

immune deficiency

tuberculosis

prospective studies

diagnostic algorithms