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 Table of Contents  
SHORT COMMUNICATION
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 293-296

Radiographic findings in adults with chronic cough in Nigeria


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 Publication25-Sep-2018

Correspondence Address:
Mr. Alhaji Modu Ali
Department of Radiology, Federal Neuro Psychiatric Hospital Maiduguri, P.M.B 1322 Maiduguri, Borno State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_160_18

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  Abstract 


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

How to cite this URL:
Gubio FA, Abubakar A, Ali AM. Radiographic findings in adults with chronic cough in Nigeria. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 15];11:293-6. Available from: http://www.ijournalhs.org/text.asp?2018/11/3/293/242038




  Introduction Top


A cough is one of the most common symptoms for which patients seek medical attention.[1] 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.[1]

A chronic cough can be defined as a persistently troublesome cough lasting for >3 weeks.[2] 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.[3] Several studies have attempted to delineate the causes of a chronic cough and have reached the same conclusion in the absence of smoking.[1],[4] 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.[5]

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.[6] However, a study in Nigeria revealed a low prevalence of cough among adults.[7] 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.[8]

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 Top


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 Top


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].
Table 1: Cough duration

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Table 2: Smoking status of the study participants

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Table 3: Radiographic lung changes among the study participants

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Table 4: Changes in the heart size of the study participants

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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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Table 5: Radiological diagnosis based on radiographic appearances

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  Discussion Top


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.[9] 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.[7] 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.[2],[7] The prevalence of smoking in this study was 8% which corresponds to what was obtained in the urban community in Nigeria.[7]

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 [1] and, in general, there is agreement that the cases of PTB nearly always cause detectable abnormalities on chest radiograph.[1]

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.[1] 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,[10] and the prevalence of asthma varies with the study in which asthma was the second common cause of a chronic cough.[2]


  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abdulrazaq YM, Minshed JA. Does normal chest X-ray in patients with chronic cough exclude pulmonary tuberculosis? IPMJ Iraqi Postgrad Med J 2011;10:130-3.  Back to cited text no. 1
    
2.
Pushpa Y, Jain DG, Agarwal AK. Evaluating chronic cough. J Indian Acad Clin Med 2002;3:240-51.  Back to cited text no. 2
    
3.
Chung KF, Pavord ID. Prevalence, pathogenesis and causes of chronic cough. Lancet 2008; 371-74  Back to cited text no. 3
    
4.
Damaraju D, Steiner T, Wade J, Gin K, FitzGerald JM. clinical problem-solving. A surprising cause of chronic cough. N Engl J Med 2015;373:561-6.  Back to cited text no. 4
    
5.
D'Urzo A, Jugovic P. Chronic cough. Three most common causes. Can Fam Physician 2002;48:1311-6.  Back to cited text no. 5
    
6.
Dye C, Harries AD, Maher D, Hosseini SM, Nkhoma W, Salaniponi FM. Tuberculosis. In: Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, et al., editors. Disease and Mortality in Sub-Saharan Africa. 2nd ed., Ch. 13. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2285/. [Last accessed on 2017 Feb 26].  Back to cited text no. 6
    
7.
Desalu OO, Salami AK, Fawibe AE. Prevalence of cough among adults in an urban community in Nigeria. West Afr J Med 2011;30:337-41.  Back to cited text no. 7
    
8.
Micheal JD, Dominic AB, Rachel EH. Oxford Handbook of Medical Imaging. 1st ed. New York: Oxford University Press; 2012. p. 44-87.  Back to cited text no. 8
    
9.
McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M, et al. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax 1998;53:738-43.  Back to cited text no. 9
    
10.
Fiberesima FP, Onwuchekwa AC. Community acquired pneumonia in Port Harcourt Rivers State of Nigeria. Cent Afr J Med 2008;54:  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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