Distribution pattern of respiratory symptoms and the relevant risk factors in patients with pulmonary nodules: A cross-sectional study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Haijie ^1,2 , ZHUANG Weitao ³ , WANG Qi ⁴ , WU Junhan ^1,3 , WU Hansheng ² , CHEN Yali ³ , TANG Yong ³ ,  QIAO Guibin ³

1. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
3. Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
4. School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, P. R. China;

Corresponding author：

QIAO Guibin, Email: guibinqiao@126.com

Keywords：

Pulmonary nodule; respiratory symptom; risk factor; anxiety; depression

DOI：

10.7507/1007-4848.202206045

Video：

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Objective To explore the distribution pattern of respiratory symptoms and relevant factors in patients with pulmonary nodules. Methods Demographic and clinical information were collected from patients who visited the Thoracic Surgery Outpatient Clinic of Guangdong Provincial People’s Hospital from January 2021 to January 2022. Hospital Anxiety and Depression Scale (HADS) was used to assess their anxiety and depression level. Results A total of 1173 patients were enrolled, including 449 males and 724 females, with an average age of 46.94±11.43 years. Among the patients with pulmonary nodules, 37.7% of them had at least one respiratory symptom; 24.4% had cough, 14.0% had expectoration, 1.3% had hemoptysis and 14.9% had chest pain. Old age, male, exposure to second-hand smoking or environmental smoke, hair coloring and history of tuberculosis were major risk factors for respiratory symptoms (P<0.05). Middle age, old age, male, exposure to environmental smoke were major risk factors for cough (P<0.05); old age, smoking, larger maximum nodules diameters, exposure to environmental smoke and history of pneumonia were major risk factors for expectoration (P<0.05); male, multiple nodules, hair coloring, exposure to second-hand smoking and history of tuberculosis were major risk factors for chest pain (P<0.05). Symptomatic patients showed generally higher HADS scores than asymptomatic patients (P<0.001). Conclusion Cough, expectoration and chest pain are the predominant respiratory symptoms for patients with pulmonary nodules. The presentation of respiratory symptoms increases patients' anxiety and depression.

Citation： XU Haijie, ZHUANG Weitao, WANG Qi, WU Junhan, WU Hansheng, CHEN Yali, TANG Yong, QIAO Guibin. Distribution pattern of respiratory symptoms and the relevant risk factors in patients with pulmonary nodules: A cross-sectional study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1175-1180. doi: 10.7507/1007-4848.202206045 Copy

1.	Anderson IJ, Davis AM. Incidental pulmonary nodules detected on CT images. JAMA, 2018, 320(21): 2260-2261.
2.	Au-Yong ITH, Hamilton W, Rawlinson J, et al. Pulmonary nodules. BMJ, 2020, 371: m3673.
3.	Slatore CG, Wiener RS, Laing AD. What is a lung nodule? Am J Respir Crit Care Med, 2016, 193(7): P11-P12.
4.	Freiman MR, Clark JA, Slatore CG, et al. Patients' knowledge, beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: Results from a multicenter survey. J Thorac Oncol, 2016, 11(5): 700-708.
5.	Xiao R, Huang Y, Meng S, et al. A cross-sectional study of psychological burden in Chinese patients with pulmonary nodules: Prevalence and impact on the management of nodules. Thorac Cancer, 2021, 12(23): 3150-3156.
6.	Slatore CG, Wiener RS. Pulmonary nodules: A small problem for many, severe distress for some, and how to communicate about it. Chest, 2018, 153(4): 1004-1015.
7.	Wiener DC, Wiener RS. Patient-centered, guideline-concordant discussion and management of pulmonary nodules. Chest, 2020, 158(1): 416-422.
8.	Slatore CG, Wiener RS, Golden SE, et al. Longitudinal assessment of distress among veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(11): 1983-1991.
9.	Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax, 2015, 70 Suppl 2: ii1-ii54.
10.	姜潇, 丛舒, 杨淼, 等. 中国居民慢性呼吸道症状流行情况及其影响因素分析. 中华流行病学杂志, 2022, 43(3): 315-323.
11.	Yang Y, Ding R, Hu D, et al. Reliability and validity of a Chinese version of the HADS for screening depression and anxiety in psycho-cardiological outpatients. Compr Psychiatry, 2014, 55(1): 215-220.
12.	Deng Y, He S, Wang J. Validation of the Hospital Anxiety and Depression Scale and the Perceived Stress Scale and psychological features in patients with periodontitis. J Periodontol, 2021, 92(11): 1601-1612.
13.	Wu Y, Levis B, Sun Y, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: Systematic review and individual participant data meta-analysis. BMJ, 2021, 373: n972.
14.	van Os S, Syversen A, Whitaker KL, et al. Lung cancer symptom appraisal, help-seeking and diagnosis—Rapid systematic review of differences between patients with and without a smoking history. Psychooncology, 2022, 31(4): 562-576.
15.	Toumazis I, Bastani M, Han SS, et al. Risk-based lung cancer screening: A systematic review. Lung Cancer, 2020, 147: 154-186.
16.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
17.	Jee HG, Kim BA, Kim M, et al. Expression of SLC5A5 in circulating tumor cells may distinguish follicular thyroid carcinomas from adenomas: Implications for blood-based preoperative diagnosis. J Clin Med, 2019, 8(2): 257.
18.	Li L, Zhao Y, Li H. Assessment of anxiety and depression in patients with incidental pulmonary nodules and analysis of its related impact factors. Thorac Cancer, 2020, 11(6): 1433-1442.
19.	Clark ME, Bedford LE, Young B, et al. Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules. Lung Cancer, 2018, 124: 160-167.
20.	Jiang G, Chen C, Zhu Y, et al. Shanghai Pulmonary Hospital experts consensus on the management of ground-glass nodules suspected as lung adenocarcinoma (Version 1). Zhongguo Fei Ai Za Zhi, 2018, 21(3): 147-159.
21.	Zhuang W, Tang Y, Xu W, et al. Should psychological distress be listed as a surgical indication for indeterminate pulmonary nodules: Protocol for a prospective cohort study in real-world settings. J Thorac Dis, 2022, 14(3): 769-778.
22.	Andersson E, Dai Ydrefelt Y, Johannesson M, et al. Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): Psychosocial consequences and impact on health-related quality of life—A multicentre prospective cross-sectional study. BMJ Open, 2021, 11(9): e048721.
23.	Morrison EJ, Novotny PJ, Sloan JA, et al. Emotional problems, quality of life, and symptom burden in patients with lung cancer. Clin Lung Cancer, 2017, 18(5): 497-503.

1. Anderson IJ, Davis AM. Incidental pulmonary nodules detected on CT images. JAMA, 2018, 320(21): 2260-2261.
2. Au-Yong ITH, Hamilton W, Rawlinson J, et al. Pulmonary nodules. BMJ, 2020, 371: m3673.
3. Slatore CG, Wiener RS, Laing AD. What is a lung nodule? Am J Respir Crit Care Med, 2016, 193(7): P11-P12.
4. Freiman MR, Clark JA, Slatore CG, et al. Patients' knowledge, beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: Results from a multicenter survey. J Thorac Oncol, 2016, 11(5): 700-708.
5. Xiao R, Huang Y, Meng S, et al. A cross-sectional study of psychological burden in Chinese patients with pulmonary nodules: Prevalence and impact on the management of nodules. Thorac Cancer, 2021, 12(23): 3150-3156.
6. Slatore CG, Wiener RS. Pulmonary nodules: A small problem for many, severe distress for some, and how to communicate about it. Chest, 2018, 153(4): 1004-1015.
7. Wiener DC, Wiener RS. Patient-centered, guideline-concordant discussion and management of pulmonary nodules. Chest, 2020, 158(1): 416-422.
8. Slatore CG, Wiener RS, Golden SE, et al. Longitudinal assessment of distress among veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(11): 1983-1991.
9. Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax, 2015, 70 Suppl 2: ii1-ii54.
10. 姜潇, 丛舒, 杨淼, 等. 中国居民慢性呼吸道症状流行情况及其影响因素分析. 中华流行病学杂志, 2022, 43(3): 315-323.
11. Yang Y, Ding R, Hu D, et al. Reliability and validity of a Chinese version of the HADS for screening depression and anxiety in psycho-cardiological outpatients. Compr Psychiatry, 2014, 55(1): 215-220.
12. Deng Y, He S, Wang J. Validation of the Hospital Anxiety and Depression Scale and the Perceived Stress Scale and psychological features in patients with periodontitis. J Periodontol, 2021, 92(11): 1601-1612.
13. Wu Y, Levis B, Sun Y, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: Systematic review and individual participant data meta-analysis. BMJ, 2021, 373: n972.
14. van Os S, Syversen A, Whitaker KL, et al. Lung cancer symptom appraisal, help-seeking and diagnosis—Rapid systematic review of differences between patients with and without a smoking history. Psychooncology, 2022, 31(4): 562-576.
15. Toumazis I, Bastani M, Han SS, et al. Risk-based lung cancer screening: A systematic review. Lung Cancer, 2020, 147: 154-186.
16. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
17. Jee HG, Kim BA, Kim M, et al. Expression of SLC5A5 in circulating tumor cells may distinguish follicular thyroid carcinomas from adenomas: Implications for blood-based preoperative diagnosis. J Clin Med, 2019, 8(2): 257.
18. Li L, Zhao Y, Li H. Assessment of anxiety and depression in patients with incidental pulmonary nodules and analysis of its related impact factors. Thorac Cancer, 2020, 11(6): 1433-1442.
19. Clark ME, Bedford LE, Young B, et al. Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules. Lung Cancer, 2018, 124: 160-167.
20. Jiang G, Chen C, Zhu Y, et al. Shanghai Pulmonary Hospital experts consensus on the management of ground-glass nodules suspected as lung adenocarcinoma (Version 1). Zhongguo Fei Ai Za Zhi, 2018, 21(3): 147-159.
21. Zhuang W, Tang Y, Xu W, et al. Should psychological distress be listed as a surgical indication for indeterminate pulmonary nodules: Protocol for a prospective cohort study in real-world settings. J Thorac Dis, 2022, 14(3): 769-778.
22. Andersson E, Dai Ydrefelt Y, Johannesson M, et al. Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): Psychosocial consequences and impact on health-related quality of life—A multicentre prospective cross-sectional study. BMJ Open, 2021, 11(9): e048721.
23. Morrison EJ, Novotny PJ, Sloan JA, et al. Emotional problems, quality of life, and symptom burden in patients with lung cancer. Clin Lung Cancer, 2017, 18(5): 497-503.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Distribution pattern of respiratory symptoms and the relevant risk factors in patients with pulmonary nodules: A cross-sectional study

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