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.	中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2021). 中华结核和呼吸杂志, 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.	赖克方, 刘宝娟. 激素敏感性咳嗽的临床特征与治疗. 中国临床医生, 2014, 42(7): 8-10.
6.	上海市医学会呼吸病学专科分会哮喘学组. 激素敏感性咳嗽诊治上海专家共识. 上海医学, 2022, 45(6): 373-379.
7.	张巧, 马千里, 程晓明, 等. 以经验性治疗为主的慢性咳嗽诊治研究. 中华肺部疾病杂志(电子版), 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.	黄芸, 余莉, 徐镶怀, 等. 中文版Hull气道反流问卷的验证及其在慢性咳嗽评估中的应用价值. 中华结核和呼吸杂志, 2016, 39(5): 355-361.
12.	赖克方, 陈如冲, 林玲, 等. 不同病因慢性咳嗽临床特征的诊断价值. 中华结核和呼吸杂志, 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.	张利, 邱忠民. 咳嗽变异性哮喘的争议问题. 中国呼吸与危重监护杂志, 2021, 20(9): 609-612.
16.	马彬, 宁康. 上气道咳嗽综合征诊治研究进展. 临床医学研究与实践, 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.	刘春丽, 赖克方, 陈如冲, 等. 胃食管反流性咳嗽的临床特征与诊断探讨. 中华内科杂志, 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.	迟辉, 高颖. 基于决策树法探析高颖教授辨治失眠主方主症规律. 世界中医药, 2021, 16(16): 2484-2492.
21.	陈君君, 路红春, 梁宇鸣, 等. 二胎产妇产后抑郁的影响因素分析以及决策树预测模型构建. 右江民族医学院学报, 2023, 45(4): 607-612.
22.	张铃林, 王青青, 易芳, 等. 基于决策树的结直肠癌风险预测模型研究. 现代预防医学, 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. 中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2021). 中华结核和呼吸杂志, 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. 赖克方, 刘宝娟. 激素敏感性咳嗽的临床特征与治疗. 中国临床医生, 2014, 42(7): 8-10.
6. 上海市医学会呼吸病学专科分会哮喘学组. 激素敏感性咳嗽诊治上海专家共识. 上海医学, 2022, 45(6): 373-379.
7. 张巧, 马千里, 程晓明, 等. 以经验性治疗为主的慢性咳嗽诊治研究. 中华肺部疾病杂志(电子版), 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. 黄芸, 余莉, 徐镶怀, 等. 中文版Hull气道反流问卷的验证及其在慢性咳嗽评估中的应用价值. 中华结核和呼吸杂志, 2016, 39(5): 355-361.
12. 赖克方, 陈如冲, 林玲, 等. 不同病因慢性咳嗽临床特征的诊断价值. 中华结核和呼吸杂志, 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. 张利, 邱忠民. 咳嗽变异性哮喘的争议问题. 中国呼吸与危重监护杂志, 2021, 20(9): 609-612.
16. 马彬, 宁康. 上气道咳嗽综合征诊治研究进展. 临床医学研究与实践, 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. 刘春丽, 赖克方, 陈如冲, 等. 胃食管反流性咳嗽的临床特征与诊断探讨. 中华内科杂志, 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. 迟辉, 高颖. 基于决策树法探析高颖教授辨治失眠主方主症规律. 世界中医药, 2021, 16(16): 2484-2492.
21. 陈君君, 路红春, 梁宇鸣, 等. 二胎产妇产后抑郁的影响因素分析以及决策树预测模型构建. 右江民族医学院学报, 2023, 45(4): 607-612.
22. 张铃林, 王青青, 易芳, 等. 基于决策树的结直肠癌风险预测模型研究. 现代预防医学, 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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