|Year : 2018 | Volume
| Issue : 3 | Page : 293-296
Radiographic findings in adults with chronic cough in Nigeria
Falmata Audu Gubio1, Ahmed Abubakar1, Alhaji Modu Ali2
1 Department of Radiology, Federal Neuro Psychiatric Hospital, Maiduguri, Borno State, Nigeria
2 Department of Radiology, Federal Neuro Psychiatric Hospital, Maiduguri, Borno State; Department of Radiography/Radiological Sciences, Faculty of Health Sciences and Technology, Nnamdi Azikwe University, Nnewi, Anambra State, Nigeria
|Date of Web Publication||25-Sep-2018|
Mr. Alhaji Modu Ali
Department of Radiology, Federal Neuro Psychiatric Hospital Maiduguri, P.M.B 1322 Maiduguri, Borno State
Source of Support: None, Conflict of Interest: None
BACKGROUND: A cough is the major functional mechanism which is responsible for the clearance of secretions from the respiratory tract and serves as an important defense mechanism, and chest X-ray is the commonly indicated examination in this category of patients for possible diagnosis and treatment.
AIMS: This study aimed at evaluating the spectrum of findings among patients presented with a chronic cough in the tropics.
MATERIALS AND METHODS: A prospective study design was used to obtain data over a period of 3 months (March–May 2018). Adult patients aged 18 years and above who presented to the department with indication of chronic cough and plain posteroanterior chest radiographs with optimum diagnostic value were included in the study. All the radiographs were reported by a radiologist. The age, sex, coughing duration, lung changes, heart changes, and diagnosis were recorded. Data were analyzed using the SPSS software version 22.0.
RESULTS: A total of fifty patients with a chronic cough were included in the study. The male-to-female ratio (M:F) was approximately 3:2. The mean age of the patients was 43.88 ± 19.24 years (range, 18–95 years). Forty-six (92.0%) patients were nonsmokers, while four (8%) were smokers. Radiographs of the twenty (40%) patients appeared normal, while thirty (60%) were abnormal, with lung opacities accounted for 34% and 26% for the right and left lungs, respectively.
CONCLUSION: Chest X-ray in patients with a chronic cough nearly always causes detectable changes and lung opacity was the commonest lung change. These patterns corroborated with most studies that have been done.
Keywords: Chest, chronic cough, diagnosis, opacity, radiograph
|How to cite this article:|
Gubio FA, Abubakar A, Ali AM. Radiographic findings in adults with chronic cough in Nigeria. Indian J Health Sci Biomed Res 2018;11:293-6
| Introduction|| |
A cough is one of the most common symptoms for which patients seek medical attention. It is a defense mechanism for clearing secretions and noxious substances from the tracheo-bronchial tree. It is a symptom of pathologic condition or process, but it may also become a means of spreading infection.
A chronic cough can be defined as a persistently troublesome cough lasting for >3 weeks. Most of the time, chronic cough is caused by a respiratory tract infection but can also be triggered choking, smoking, air pollution, asthma, gastrooesophageal reflux disease, post nasal drip, chronic bronchitis. Lung tumours, heart failures and some medications such as angiotensin-converting enzyme (ACE) inhibitors. Several studies have attempted to delineate the causes of a chronic cough and have reached the same conclusion in the absence of smoking., In the vast majority of cases, chronic cough may be attributed to one or a combination of four conditions. They include chronic bronchitis, postnasal drip syndrome, asthma, and gastroesophageal reflux disease. Having a normal chest X-ray will suggest that a cough is likely caused by one of these four entities.
Tuberculosis has been reported in all countries; it is particularly common throughout the developing world, and about 2 million people die of this curable infection. However, a study in Nigeria revealed a low prevalence of cough among adults. Based on the researcher's knowledge, there is a paucity of literature on the radiographic findings of a chronic cough in the tropics. Some radiographic features include cystic changes, fibrosis, pneumothorax, cardiomegaly, consolidation, and cavitation.
Chronic cough is a common clinical condition with heterogeneous causes; this study is aimed at assessing the spectrum of X-ray findings in the tropics.
| Materials and Methods|| |
A prospective study design was used to obtain data for the study. Fifty adult chest radiographs were evaluated during the period of the study starting from March to May, 2017, at the Radiology Department, Federal Neuropsychiatric Hospital, Maiduguri, Borno State. A convenient sampling technique was employed.
All adult patients aged 18 years and above who presented to the department with an indication of chronic cough lasting for >3 weeks and plain posteroanterior chest radiographs with optimum diagnostic value were included in the study. Children aged <18 years and with indications other than chronic cough of <3 weeks were excluded from the study. High powered X-ray machine (X-R 6000) with a customized erect bucky (General electric (GE) Healthcare system, Beijing, China) was used to obtain the radiographs. Radiographs were viewed and reported by the radiologists of the department.
Data were collected using data capture sheet with sex, age, duration of a cough, smokers/nonsmokers, lung findings, heart changes, and diagnosis as parameters. The recorded data were analyzed using Statistical Package for the Social Sciences software version 22.0 (SPSS Inc., Chicago, IL, USA), a statistical computer software. The descriptive data were given as mean ± standard deviation, frequencies, and percentages.
| Results|| |
A total of fifty patients (29 males and 21 females) were included in the study. The mean age of the patients was 43.88 ± 19.24 years (range, 18–95 years). Majority of the patients (52%) had a chronic cough duration of 3–12 weeks, while only two (4%) patients had a chronic cough that lasted between 43 and 52 weeks [Table 1]. Forty-six (92.0%) patients were nonsmokers, while four (8%) were smokers [Table 2]. Lung opacities accounted for radiographs of the twenty (40%) patients who appeared normal, while thirty (60%) were abnormal with lung opacities accounted for 34% and 26% for the right and left lungs, respectively [Table 3]. Thirty-six (72.0%) patients had normal heart size, while 14 (28.0%) had an enlarged heart on the chest radiographs [Table 4] and [Figure 1]. The diagnoses were arrived at by finding the following radiological patterns on the radiographs: lung congestion, cystic changes, opacity, and pleural effusion. Of the fifty patients, 38.0% had normal chest radiographs, 30.0% presented with pulmonary tuberculosis (PTB) [Figure 1], 14.0% with pneumonia [Figure 2], 14.0% with cardiac decompensation [Figure 3], and 2.0% with asthma and pleural effusion [Table 5].
|Figure 1: A 75 year old woman with pulmonary tuberculosis. Reticulo-nodular opacities with cystic background changes involving both lung fields|
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|Figure 2: A 29 year old man with lobar pneumonia. A homogeneous opacity with an air-bronchogram sign involving the left lung field and right mid zones|
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|Figure 3: A 57 year old man with cardiomegaly of left ventricular configuration and congestion of lung fields and aortic unfolding|
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| Discussion|| |
This study was conducted among adults in Nigeria to determine the radiographic findings of chronic cough in the tropics according to the duration of a cough of 3 weeks and above. There are several epidemiological studies of chronic cough worldwide. Geographical variation arises in the definitions that are used in reporting chronic cough as well as age range in different studied populations. The age range of the studied population was 18 years and above, which disagrees with the European Community Respiratory Health Survey which was restricted to young adults (aged 20–44 years), thereby missing a large number of elderly population. Variations arise between our results and other reports and this may be due to the difference in the study methodology, seasonal variation, and high prevalence of smoking in some countries., The prevalence of smoking in this study was 8% which corresponds to what was obtained in the urban community in Nigeria.
The major findings were discussed with respect to the objectives set for the study in relation to findings from previous related studies. From this study, it can be concluded that the right lung is the most affected area on chest X-ray, with opacity being the commonest finding. Not all cases of a chronic cough rule out detectable abnormalities on chest X-ray. Detectable abnormalities were assessed for all cases diagnosed with PTB in our study, which disagrees with the previous study  and, in general, there is agreement that the cases of PTB nearly always cause detectable abnormalities on chest radiograph.
Thirty-six patients had normal heart size on chest radiograph, while 14 had enlarged heart size (cardiomegaly) as a result of a chronic cough. There is a paucity of literature on these entities to compare with our results.
Based on the diagnosis, most of the patients had normal findings on plain chest radiographs with the prevalence of 38%, which disagrees with the previous study. PTB was diagnosed as the highest factor leading to a chronic cough in our study with a prevalence of 30.0%. Pneumonia and cardiac decompensation (14%) were the second highest, while asthma and pleural effusion were the least (2%). The prevalence of pneumonia was higher compared to what was obtained in the previous report, and the prevalence of asthma varies with the study in which asthma was the second common cause of a chronic cough.
| Conclusion|| |
Chest X-ray in patients with a chronic cough nearly always causes detectable abnormalities. There is a need to enlighten the population on the importance of seeking early medical treatment, as it may be a warning sign of life-threatening or irreversible lung/or heart disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]