The simple decision tree for etiologic diagnosis of chronic cough based on the Modified Cough Assessment Test_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JIA Linjie ¹ , BAI Jia ² , MA Jiaqi ¹ , NI Wang ¹ , YU Muqing ¹ , ZHAO Jianping ¹ ,  ZHOU Min ¹

1. Department of Respiratory Diseases and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
2. Department of Cardiology, Daping Hospital, Congqing 400000, P. R. China;

Corresponding?author：

ZHOU Min, Email: minzhou@tjh.tjmu.edu.cn

Keywords：

Chronic cough; cough questionnaire; etiology; decision tree

DOI：

10.7507/1671-6205.202310025

Video：

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Objective To compare the clinical characteristics of chronic cough, and to establish the Modified Cough Assessment Test and the simple decision tree to improve the efficacy of etiologic diagnosis. Methods Patients with chronic cough consulted in Tongji Hospital between October 2021 and August 2023 were enrolled in our study. The patients with identified single cause were divided into 3 groups accordingly: corticosteroid-responsive cough (CRC), upper airway cough syndrome (UACS) and gastroesophageal reflux-related cough (GERC). And the characteristics of chronic cough in different causes were assessed and compared by cough questionnaires. Independent predictors of various causes were identified by multivariate logistic regression analysis and used to establish the Modified Cough Assessment Test (MCET) and to construct the simple decision tree. Results A total of 358 patients were enrolled, including 201 with CRC (56.1%), 125 with UACS (34.9%) and 32 with GERC (8.94%). "Cough with wheezing or chest tightness" (OR=3.222, 95%CI 2.144 - 4.843, P<0.001), "Cough with daytime heaviness and nighttime lightness" (OR=1.755, 95%CI 1.264 - 2.435, P<0.001), and "Cough with acid reflux, heartburn or indigestion" (OR=15.580, 95%CI 5.894 - 41.184, P<0.001) were independent factors for each group, respectively. The area under ROC curve for classification of CRC, UACS and GERC were 0.871, 0.840 and 0.988 for MCET, which were better than those of Leicester Cough Questionnaire (LCQ) (0.792, 0.766 and 0.913) and Cough Evaluation Test (CET) (0.649, 0.691 and 0.580). The accuracy of the simple decision tree for the differential diagnosis of chronic cough was 77.4%. Conclusion The simple decision tree based on the Modified Cough Evaluation Test is a simple and effective method of etiologic diagnosis of chronic cough, which can be used as a tool to improve the efficacy of clinical diagnosis in outpatient settings.

Citation： JIA Linjie, BAI Jia, MA Jiaqi, NI Wang, YU Muqing, ZHAO Jianping, ZHOU Min. The simple decision tree for etiologic diagnosis of chronic cough based on the Modified Cough Assessment Test. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(3): 178-184. doi: 10.7507/1671-6205.202310025 Copy

1.	中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南(2021). 中華結核和呼吸雜志, 2022, 45(1): 13-46.
2.	Ahmad SR, Iyer VN. The evolving clinical practice of chronic cough. Mayo Clin Proc, 2022, 97(6): 1164-1175.
3.	Lai K, Chen R, Lin J, et al. A prospective, multicenter survey on causes of chronic cough in China. Chest, 2013, 143(3): 613-620.
4.	Deng HY, Luo W, Zhang M, et al. Initial empirical treatment based on clinical feature of chronic cough. Clin Respir J, 2016, 10(5): 622-630.
5.	賴克方, 劉寶娟. 激素敏感性咳嗽的臨床特征與治療. 中國臨床醫生, 2014, 42(7): 8-10.
6.	上海市醫學會呼吸病學專科分會哮喘學組. 激素敏感性咳嗽診治上海專家共識. 上海醫學, 2022, 45(6): 373-379.
7.	張巧, 馬千里, 程曉明, 等. 以經驗性治療為主的慢性咳嗽診治研究. 中華肺部疾病雜志(電子版), 2010, 3(6): 402-407.
8.	Chung KF. Measurement of cough. Respir Physiol Neurobiol, 2006, 152(3): 329-339.
9.	Cho PSP, Birring SS, Fletcher HV, et al. Methods of cough assessment. J Allergy Clin Immunol Pract, 2019, 7(6): 1715-1723.
10.	Zhan W, Zhang L, Jiang M, et al. A new simple score of chronic cough: cough evaluation test. BMC Pulm Med, 2020, 20(1): 68.
11.	黃蕓, 余莉, 徐鑲懷, 等. 中文版Hull氣道反流問卷的驗證及其在慢性咳嗽評估中的應用價值. 中華結核和呼吸雜志, 2016, 39(5): 355-361.
12.	賴克方, 陳如沖, 林玲, 等. 不同病因慢性咳嗽臨床特征的診斷價值. 中華結核和呼吸雜志, 2009, 32(6): 418-421.
13.	Lai K, Zhan W, Li H, et al. The predicative clinical features associated with chronic cough that has a single underlying cause. J Allergy Clin Immunol Pract, 2021, 9(1): 426-432, e2.
14.	Jiang G, Huang X, Li T, et al. Chronic cough: clinical characteristics and etiologies of 510 cases. Turk J Med Sci, 2016, 46(6): 1734-1739.
15.	張利, 邱忠民. 咳嗽變異性哮喘的爭議問題. 中國呼吸與危重監護雜志, 2021, 20(9): 609-612.
16.	馬彬, 寧康. 上氣道咳嗽綜合征診治研究進展. 臨床醫學研究與實踐, 2017, 2(3): 197-198.
17.	Irwin RS, Zawacki JK, Curley FJ, et al. Chronic cough as the sole presenting manifestation of gastroesophageal reflux. Am Rev Respir Dis, 1989, 140(5): 1294-1300.
18.	劉春麗, 賴克方, 陳如沖, 等. 胃食管反流性咳嗽的臨床特征與診斷探討. 中華內科雜志, 2005, 44(6): 438-441.
19.	Halland M, Bharucha AE, Crowell MD, et al. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol, 2021, 116(1): 86-94.
20.	遲輝, 高穎. 基于決策樹法探析高穎教授辨治失眠主方主癥規律. 世界中醫藥, 2021, 16(16): 2484-2492.
21.	陳君君, 路紅春, 梁宇鳴, 等. 二胎產婦產后抑郁的影響因素分析以及決策樹預測模型構建. 右江民族醫學院學報, 2023, 45(4): 607-612.
22.	張鈴林, 王青青, 易芳, 等. 基于決策樹的結直腸癌風險預測模型研究. 現代預防醫學, 2023, 50(15): 2707-2713.
23.	Wang B, He Z, Yi Z, et al. Application of a decision tree model in the early identification of severepatients with severe fever with thrombocytopenia syndrome. PLoS One, 2021, 16(7): e0255033.

1. 中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南(2021). 中華結核和呼吸雜志, 2022, 45(1): 13-46.
2. Ahmad SR, Iyer VN. The evolving clinical practice of chronic cough. Mayo Clin Proc, 2022, 97(6): 1164-1175.
3. Lai K, Chen R, Lin J, et al. A prospective, multicenter survey on causes of chronic cough in China. Chest, 2013, 143(3): 613-620.
4. Deng HY, Luo W, Zhang M, et al. Initial empirical treatment based on clinical feature of chronic cough. Clin Respir J, 2016, 10(5): 622-630.
5. 賴克方, 劉寶娟. 激素敏感性咳嗽的臨床特征與治療. 中國臨床醫生, 2014, 42(7): 8-10.
6. 上海市醫學會呼吸病學專科分會哮喘學組. 激素敏感性咳嗽診治上海專家共識. 上海醫學, 2022, 45(6): 373-379.
7. 張巧, 馬千里, 程曉明, 等. 以經驗性治療為主的慢性咳嗽診治研究. 中華肺部疾病雜志(電子版), 2010, 3(6): 402-407.
8. Chung KF. Measurement of cough. Respir Physiol Neurobiol, 2006, 152(3): 329-339.
9. Cho PSP, Birring SS, Fletcher HV, et al. Methods of cough assessment. J Allergy Clin Immunol Pract, 2019, 7(6): 1715-1723.
10. Zhan W, Zhang L, Jiang M, et al. A new simple score of chronic cough: cough evaluation test. BMC Pulm Med, 2020, 20(1): 68.
11. 黃蕓, 余莉, 徐鑲懷, 等. 中文版Hull氣道反流問卷的驗證及其在慢性咳嗽評估中的應用價值. 中華結核和呼吸雜志, 2016, 39(5): 355-361.
12. 賴克方, 陳如沖, 林玲, 等. 不同病因慢性咳嗽臨床特征的診斷價值. 中華結核和呼吸雜志, 2009, 32(6): 418-421.
13. Lai K, Zhan W, Li H, et al. The predicative clinical features associated with chronic cough that has a single underlying cause. J Allergy Clin Immunol Pract, 2021, 9(1): 426-432, e2.
14. Jiang G, Huang X, Li T, et al. Chronic cough: clinical characteristics and etiologies of 510 cases. Turk J Med Sci, 2016, 46(6): 1734-1739.
15. 張利, 邱忠民. 咳嗽變異性哮喘的爭議問題. 中國呼吸與危重監護雜志, 2021, 20(9): 609-612.
16. 馬彬, 寧康. 上氣道咳嗽綜合征診治研究進展. 臨床醫學研究與實踐, 2017, 2(3): 197-198.
17. Irwin RS, Zawacki JK, Curley FJ, et al. Chronic cough as the sole presenting manifestation of gastroesophageal reflux. Am Rev Respir Dis, 1989, 140(5): 1294-1300.
18. 劉春麗, 賴克方, 陳如沖, 等. 胃食管反流性咳嗽的臨床特征與診斷探討. 中華內科雜志, 2005, 44(6): 438-441.
19. Halland M, Bharucha AE, Crowell MD, et al. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol, 2021, 116(1): 86-94.
20. 遲輝, 高穎. 基于決策樹法探析高穎教授辨治失眠主方主癥規律. 世界中醫藥, 2021, 16(16): 2484-2492.
21. 陳君君, 路紅春, 梁宇鳴, 等. 二胎產婦產后抑郁的影響因素分析以及決策樹預測模型構建. 右江民族醫學院學報, 2023, 45(4): 607-612.
22. 張鈴林, 王青青, 易芳, 等. 基于決策樹的結直腸癌風險預測模型研究. 現代預防醫學, 2023, 50(15): 2707-2713.
23. Wang B, He Z, Yi Z, et al. Application of a decision tree model in the early identification of severepatients with severe fever with thrombocytopenia syndrome. PLoS One, 2021, 16(7): e0255033.

Chinese Journal of Respiratory and Critical Care Medicine

The simple decision tree for etiologic diagnosis of chronic cough based on the Modified Cough Assessment Test

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