Bronchoscopy and laryngoscopy findings in refractory chronic cough (RCC)

<b>Background:</b> A significant proportion of patients referred to our tertiary cough clinic have a poorly described phenotype, displaying symptoms of cough hypersensitivity and expectoration of sputum. We aimed to establish the diagnostic yield of joint laryngoscopy and bronchoscopy in this group. <b>Methods:</b> We retrospectively reviewed results from 80 patients with RCC, undergoing a bronchoscopy and laryngoscopy (January 2019 to December 2020). <b>Results:</b> Bronchoscopy was requested to investigate symptoms and guide management in all cases. 43/80 patients had symptoms of cough hypersensitivity and sputum production (≥tsp to egg-cup full daily). Urge to cough came from the throat (52%), chest (30%) or both chest and throat (18 %). Positive macroscopic findings were seen in 42.5%, which included tracheopathia osteochondroplastica (5/80), airway collapsibility 27/80 and tracheobronchomalacia (1/80). Eosinophilic bronchitis (Eos &gt;1 %) was seen in 6% of cases and neutrophilia (&gt;3%) was seen in 88% of patients. Mean cell counts in 68 patients undergoing BAL were eosinophils 0.28% +/- 0.85, lymphocytes 11.75 % +/-9.7, neutrophils 18% +/-14.95 and macrophages 50% +/-16.2. Bacterial growth was detected in 7% of cases. Laryngoscopy showed inducible laryngeal obstruction or sensitivity in 35% and other upper airway findings in 18% (mucus, inflammation, nasal polyps). Findings influenced management choices; Azithromycin (10/80), hypertonic saline and chest physio (13/80), speech and language therapy (14/80) and anti-tussives (18/80) were initiated post procedure. <b>Conclusion:</b> Our data supports the value of bronchoscopy and laryngoscopy in RCC, especially in individuals with productive cough and features of cough hypersensitivity.