Risk factors of persistent cough after pneumonectomy: Systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QUAN dandan ^1,2 , HONG jingfang ¹ , ZHANG tian ² , LI congling ²

1. School of Nursing, Anhui Medical University, Hefei, 230032, P. R. China;
2. Department of Thoracic Surgery, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, 230000, P. R. China;

Corresponding author：

Keywords：

Pneumonectomy; persistent cough; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202307014

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Objective To systematically evaluate the risk factors forpersistent cough after pneumonectomy and to provide a theoretical basis for the prevention of persistent cough after surgery. Methods Researches on risk factors of persistent cough after pneumonectomy were retrieved from The Cochrane Library, Web of Science, Embase, PubMed, CBM, Wanfang, CNKI and VIP from inception to March 30, 2023. Two researchers screened the literature, extracted data, and conducted quality evaluation. Meta-analysis was performed using RevMan 5.3 software. Results Seventeen studies with a total of 3 698 patients were finally included. Meta-analysis results showed that: female [OR=3.10, 95%CI (1.99, 4.81), P<0.001], age<63 years [OR=1.72, 95%CI (1.33, 2.21), P<0.001], right lung surgery [OR=2.36, 95%CI(1.80, 3.10), P<0.001], lobectomy [OR=3.40, 95%CI (2.47, 4.68), P<0.001], upper lobectomy [OR=8.19, 95%CI (3.87, 17.36)], lymph node dissection [OR=3.59, 95%CI(2.72, 4.72), P<0.001], bronchial stump approach [OR=5.19, 95%CI(1.79, 16.07), P=0.002], and postoperative acid reflux [OR=6.24, 95%CI(3.27, 11.91), P<0.001] were all risk factors for persistent cough after pneumonectomy (P<0.05). Smoking history [OR=0.59, 95%CI(0.45, 0.77), , P<0.001] was a protective factor for postoperative cough. In addition, the quality of life score (LCQ-MC) of patients with cough after surgery was lower than that before surgery [MD=1.50, 95%CI(0.14,2.86), P=0.03]. Conclusion Available evidence suggests that female, age <63 years, right lung surgery, lobectomy, lymph node dissection, bronchial stump approach (suture clamp closure), and postoperative acid reflux are independent risk factors for persistent postoperative cough in patients undergoing lung resection, while smoking history may be a protective factor forpostoperative cough. It provides an evidence-based evidence for clinical medical staff to prevent and reduce postoperative persistent cough and improve the quality of life of patients in the future.

1.	Sawabata N, Maeda H, Takeda S, et al. Persistent cough following pulmonary resection: Observational and empiric study of possible causes. Ann Thorac Surg, 2005, 79(1): 289-293.
2.	Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest, 2004, 125(2): 439-445.
3.	Liao J, Wang Y, Dai W, et al. Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: A cross-sectional analysis. J Cardiothorac Surg, 2022, 17(1): 229.
4.	Molassiotis A, Smith JA, Mazzone P, et al. Symptomatic treatment of cough among adult patients with lung cancer: CHEST guideline and expert panel report. Chest, 2017, 151(4): 861-874.
5.	Xie MR, Zhu YF, Zhou MQ, et al. Analysis of factors related to chronic cough after lung cancer surgery. Thorac Cancer, 2019, 10(4): 898-903.
6.	慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017, 17(7): 577-580.
7.	Lu XF, Min XP, Lu B, et al. Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients. Quant Imaging Med Surg, 2022, 12(1): 196-206.
8.	Wu X, Xing H, Chen P, et al. Lymph node dissection is a risk factor for short-term cough after pulmonary resection. Curr Oncol, 2022, 29(1): 294-307.
9.	张奕, 解纲, 李波. 非小细胞肺癌患者电视胸腔镜术后慢性咳嗽的影响因素及治疗. 中国肿瘤临床与康复, 2022, 29(3): 299-302.
10.	马涵. 胸腔镜下肺肿瘤术后慢性咳嗽的临床研究. 苏州大学, 2019.
11.	钱鹏, 朱峰, 马冬春, 等. 接受单孔胸腔镜肿瘤切除术治疗非小细胞肺癌患者术后出现持续性咳嗽的危险因素. 山东医药, 2021, 61(9): 74-76.
12.	吴子恒, 徐惟, 许世广, 等. 达芬奇机器人与电视胸腔镜非小细胞肺癌术后慢性咳嗽危险因素分析及应对策略. 中国胸心血管外科临床杂志, 2020, 27(11): 1274-1280.
13.	辛五群, 陈晓, 汤金星, 等. 肺癌经胸腔镜切除术后继发持续性咳嗽的影响因素分析. 结核病与肺部健康杂志, 2021, 2(1): 31-37.
14.	Pan LY, Peng LP, Xu C, et al. Predictive factors of cough after uniportal video-assisted thoracoscopic pulmonary resection. J Thorac Dis, 2020, 12(10): 5958-5969.
15.	崔慧琴, 王舒蓉, 顾玉晶. 老年肺癌患者胸腔镜下肺癌切除术后继发持续性咳嗽的危险因素探讨. 老年医学与保健, 2023, 29(1): 63-67.
16.	董仙英, 徐琪纹, 钟娟. 肺癌患者术后并发慢性咳嗽的危险因素分析. 护士进修杂志, 2022, 37(9): 783-786.
17.	董艳, 孟醒, 刘旭岚, 等. 肺癌胸腔镜肺切除术后发生持续咳嗽的相关危险因素分析. 航空航天医学杂志, 2022, 33(12): 1475-1477.
18.	高永山, 张志杰, 付伟, 等. 非小细胞肺癌经单操作孔胸腔镜肺段切除术后并发持续咳嗽的危险因素分析. 山东医药, 2022, 62(11): 77-79.
19.	贺静晗, 崔璨, 贾宇, 等. 非小细胞肺癌患者胸腔镜手术后持续咳嗽发生的影响因素. 国际医药卫生导报, 2022, 28(16): 2241-2245.
20.	李理响, 汪国文, 王康武, 等. 肺切除术后不可耐受性咳嗽的危险因素分析. 中华解剖与临床杂志, 2022, 27(7): 491-495.
21.	马志飞, 张爱平, 黄福华, 等. 非小细胞肺癌患者肺叶切除术后持续干咳的影响因素. 江苏医药, 2022, 48(9): 887-890.
22.	殷优宏, 戎国祥, 张帆. 非小细胞肺癌患者电视胸腔镜微创术后发生慢性咳嗽的影响因素. 中国当代医药, 2021, 28(36): 80-82.
23.	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(2015). 中华结核和呼吸杂志, 2016, 39(5): 323-354.
24.	Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129(1 Suppl): 1S-23S.
25.	Kavalcikova-Bogdanova N, Buday T, Plevkova J, et al. Chronic cough as a female gender issue. Adv Exp Med Biol, 2016, 905: 69-78.
26.	Morice AH, Jakes AD, Faruqi S, et al. A worldwide survey of chronic cough: A manifestation of enhanced somatosensory response. Eur Respir J, 2014, 44(5): 1149-1155.
27.	车国卫, 李为民, 刘伦旭. 快速肺康复需要围手术期流程优化. 中国胸心血管外科临床杂志, 2016, 23(3): 216-220.
28.	Dicpinigaitis PV. Cough reflex sensitivity in cigarette smokers. Chest, 2003, 123(3): 685-688.
29.	Dicpinigaitis PV. Effect of tobacco and electronic cigarette use on cough reflex sensitivity. Pulm Pharmacol Ther, 2017, 47: 45-48.
30.	Dicpinigaitis PV, Sitkauskiene B, Stravinskaite K, et al. Effect of smoking cessation on cough reflex sensitivity. Eur Respir J, 2006, 28(4): 786-790.
31.	Dicpinigaitis PV, Lee Chang A, Dicpinigaitis AJ, et al. Effect of e-cigarette use on cough reflex sensitivity. Chest, 2016, 149(1): 161-165.
32.	Mazurov A, Ho J, Low T, et al. Novel α7 nicotinic acetylcholine receptor modulators as potential antitussive agents. Bioorg Med Chem Lett, 2023, 80: 129067.
33.	Canning BJ, Liu Q, Tao M, et al. Evidence for alpha7 nicotinic receptor activation during the cough suppressing effects induced by nicotine and identification of ATA-101 as a potential novel therapy for the treatment of chronic cough. J Pharmacol Exp Ther, 2022, 380(2): 94-103.
34.	赵凌云, 李宏云. 慢性咳嗽的治疗新进展. 中国全科医学, 2021, 24(8): 930-940,946.
35.	Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage Ⅰnon-small cell lung cancer. J Surg Res, 2011, 166(1): 46-51.
36.	纪林林, 李鑫, 朱建平, 等. 保留下肺韧带对胸腔镜下肺上叶切除术后持续性咳嗽的影响. 天津医药, 2018, 46(12): 1308-1312.
37.	Huang J, Luo Q, Tan Q, et al. Evaluation of the surgical fat-filling procedure in the treatment of refractory cough after systematic mediastinal lymphadenectomy in patients with right lung cancer. J Surg Res, 2014, 187(2): 490-495.
38.	苏东辉, 金健. 肺切除术后持续咳嗽影响因素的研究现状. 四川医学, 2021, 42(12): 1264-1268.
39.	赵军山, 解少男, 王刚, 等. 肺切除支气管残端不同结扎方法对肺癌术后早期并发症的影响. 疑难病杂志, 2015(1): 73-75.
40.	蔡松旺, 廖洪映, 韦正超, 等. 可吸收缝线连续缝合+加扎法处理肺癌支气管残端. 中山大学学报(医学科学版), 2009, 30(z2): 177-179.
41.	Harle ASM, Blackhall FH, Molassiotis A, et al. Cough in patients with lung cancer: A longitudinal observational study of characterization and clinical associations. Chest, 2019, 155(1): 103-113.
42.	Sawabata N, Takeda S, Tokunaga T, et al. Acid regurgitation associated with persistent cough after pulmonary resection: An observational study. Cough, 2006, 2: 9.
43.	马凤艳, 刘燕, 任娜, 等. 加速康复外科理念下肺癌患者胸腔镜术后咳嗽相关生命质量现状及影响因素分析. 中国实用护理杂志, 2021, 37(35): 2774-2778.
44.	黄群, 陈兰, 周淋琳, 等. 肺癌患者术后咳嗽相关生活质量现况及其影响因素. 解放军护理杂志, 2018, 35(8): 18-22.
45.	林嵘嘉, 车国卫, 徐志华, 等. 肺癌患者电视胸腔镜手术后咳嗽的影响因素分析: 单中心前瞻性研究. 中国胸心血管外科临床杂志, 2017, 24(10): 748-752.
46.	Harle A, Molassiotis A, Buffin O, et al. A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need. BMC Cancer, 2020, 20(1): 9.
47.	王天佑, 李单青, 崔永等. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.

1. Sawabata N, Maeda H, Takeda S, et al. Persistent cough following pulmonary resection: Observational and empiric study of possible causes. Ann Thorac Surg, 2005, 79(1): 289-293.
2. Sarna L, Evangelista L, Tashkin D, et al. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest, 2004, 125(2): 439-445.
3. Liao J, Wang Y, Dai W, et al. Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: A cross-sectional analysis. J Cardiothorac Surg, 2022, 17(1): 229.
4. Molassiotis A, Smith JA, Mazzone P, et al. Symptomatic treatment of cough among adult patients with lung cancer: CHEST guideline and expert panel report. Chest, 2017, 151(4): 861-874.
5. Xie MR, Zhu YF, Zhou MQ, et al. Analysis of factors related to chronic cough after lung cancer surgery. Thorac Cancer, 2019, 10(4): 898-903.
6. 慕腾, 姜冠潮, 李晓, 等. 胸腔镜肺切除术后持续咳嗽的多因素分析. 中国微创外科杂志, 2017, 17(7): 577-580.
7. Lu XF, Min XP, Lu B, et al. Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients. Quant Imaging Med Surg, 2022, 12(1): 196-206.
8. Wu X, Xing H, Chen P, et al. Lymph node dissection is a risk factor for short-term cough after pulmonary resection. Curr Oncol, 2022, 29(1): 294-307.
9. 张奕, 解纲, 李波. 非小细胞肺癌患者电视胸腔镜术后慢性咳嗽的影响因素及治疗. 中国肿瘤临床与康复, 2022, 29(3): 299-302.
10. 马涵. 胸腔镜下肺肿瘤术后慢性咳嗽的临床研究. 苏州大学, 2019.
11. 钱鹏, 朱峰, 马冬春, 等. 接受单孔胸腔镜肿瘤切除术治疗非小细胞肺癌患者术后出现持续性咳嗽的危险因素. 山东医药, 2021, 61(9): 74-76.
12. 吴子恒, 徐惟, 许世广, 等. 达芬奇机器人与电视胸腔镜非小细胞肺癌术后慢性咳嗽危险因素分析及应对策略. 中国胸心血管外科临床杂志, 2020, 27(11): 1274-1280.
13. 辛五群, 陈晓, 汤金星, 等. 肺癌经胸腔镜切除术后继发持续性咳嗽的影响因素分析. 结核病与肺部健康杂志, 2021, 2(1): 31-37.
14. Pan LY, Peng LP, Xu C, et al. Predictive factors of cough after uniportal video-assisted thoracoscopic pulmonary resection. J Thorac Dis, 2020, 12(10): 5958-5969.
15. 崔慧琴, 王舒蓉, 顾玉晶. 老年肺癌患者胸腔镜下肺癌切除术后继发持续性咳嗽的危险因素探讨. 老年医学与保健, 2023, 29(1): 63-67.
16. 董仙英, 徐琪纹, 钟娟. 肺癌患者术后并发慢性咳嗽的危险因素分析. 护士进修杂志, 2022, 37(9): 783-786.
17. 董艳, 孟醒, 刘旭岚, 等. 肺癌胸腔镜肺切除术后发生持续咳嗽的相关危险因素分析. 航空航天医学杂志, 2022, 33(12): 1475-1477.
18. 高永山, 张志杰, 付伟, 等. 非小细胞肺癌经单操作孔胸腔镜肺段切除术后并发持续咳嗽的危险因素分析. 山东医药, 2022, 62(11): 77-79.
19. 贺静晗, 崔璨, 贾宇, 等. 非小细胞肺癌患者胸腔镜手术后持续咳嗽发生的影响因素. 国际医药卫生导报, 2022, 28(16): 2241-2245.
20. 李理响, 汪国文, 王康武, 等. 肺切除术后不可耐受性咳嗽的危险因素分析. 中华解剖与临床杂志, 2022, 27(7): 491-495.
21. 马志飞, 张爱平, 黄福华, 等. 非小细胞肺癌患者肺叶切除术后持续干咳的影响因素. 江苏医药, 2022, 48(9): 887-890.
22. 殷优宏, 戎国祥, 张帆. 非小细胞肺癌患者电视胸腔镜微创术后发生慢性咳嗽的影响因素. 中国当代医药, 2021, 28(36): 80-82.
23. 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(2015). 中华结核和呼吸杂志, 2016, 39(5): 323-354.
24. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129(1 Suppl): 1S-23S.
25. Kavalcikova-Bogdanova N, Buday T, Plevkova J, et al. Chronic cough as a female gender issue. Adv Exp Med Biol, 2016, 905: 69-78.
26. Morice AH, Jakes AD, Faruqi S, et al. A worldwide survey of chronic cough: A manifestation of enhanced somatosensory response. Eur Respir J, 2014, 44(5): 1149-1155.
27. 车国卫, 李为民, 刘伦旭. 快速肺康复需要围手术期流程优化. 中国胸心血管外科临床杂志, 2016, 23(3): 216-220.
28. Dicpinigaitis PV. Cough reflex sensitivity in cigarette smokers. Chest, 2003, 123(3): 685-688.
29. Dicpinigaitis PV. Effect of tobacco and electronic cigarette use on cough reflex sensitivity. Pulm Pharmacol Ther, 2017, 47: 45-48.
30. Dicpinigaitis PV, Sitkauskiene B, Stravinskaite K, et al. Effect of smoking cessation on cough reflex sensitivity. Eur Respir J, 2006, 28(4): 786-790.
31. Dicpinigaitis PV, Lee Chang A, Dicpinigaitis AJ, et al. Effect of e-cigarette use on cough reflex sensitivity. Chest, 2016, 149(1): 161-165.
32. Mazurov A, Ho J, Low T, et al. Novel α7 nicotinic acetylcholine receptor modulators as potential antitussive agents. Bioorg Med Chem Lett, 2023, 80: 129067.
33. Canning BJ, Liu Q, Tao M, et al. Evidence for alpha7 nicotinic receptor activation during the cough suppressing effects induced by nicotine and identification of ATA-101 as a potential novel therapy for the treatment of chronic cough. J Pharmacol Exp Ther, 2022, 380(2): 94-103.
34. 赵凌云, 李宏云. 慢性咳嗽的治疗新进展. 中国全科医学, 2021, 24(8): 930-940,946.
35. Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage Ⅰnon-small cell lung cancer. J Surg Res, 2011, 166(1): 46-51.
36. 纪林林, 李鑫, 朱建平, 等. 保留下肺韧带对胸腔镜下肺上叶切除术后持续性咳嗽的影响. 天津医药, 2018, 46(12): 1308-1312.
37. Huang J, Luo Q, Tan Q, et al. Evaluation of the surgical fat-filling procedure in the treatment of refractory cough after systematic mediastinal lymphadenectomy in patients with right lung cancer. J Surg Res, 2014, 187(2): 490-495.
38. 苏东辉, 金健. 肺切除术后持续咳嗽影响因素的研究现状. 四川医学, 2021, 42(12): 1264-1268.
39. 赵军山, 解少男, 王刚, 等. 肺切除支气管残端不同结扎方法对肺癌术后早期并发症的影响. 疑难病杂志, 2015(1): 73-75.
40. 蔡松旺, 廖洪映, 韦正超, 等. 可吸收缝线连续缝合+加扎法处理肺癌支气管残端. 中山大学学报(医学科学版), 2009, 30(z2): 177-179.
41. Harle ASM, Blackhall FH, Molassiotis A, et al. Cough in patients with lung cancer: A longitudinal observational study of characterization and clinical associations. Chest, 2019, 155(1): 103-113.
42. Sawabata N, Takeda S, Tokunaga T, et al. Acid regurgitation associated with persistent cough after pulmonary resection: An observational study. Cough, 2006, 2: 9.
43. 马凤艳, 刘燕, 任娜, 等. 加速康复外科理念下肺癌患者胸腔镜术后咳嗽相关生命质量现状及影响因素分析. 中国实用护理杂志, 2021, 37(35): 2774-2778.
44. 黄群, 陈兰, 周淋琳, 等. 肺癌患者术后咳嗽相关生活质量现况及其影响因素. 解放军护理杂志, 2018, 35(8): 18-22.
45. 林嵘嘉, 车国卫, 徐志华, 等. 肺癌患者电视胸腔镜手术后咳嗽的影响因素分析: 单中心前瞻性研究. 中国胸心血管外科临床杂志, 2017, 24(10): 748-752.
46. Harle A, Molassiotis A, Buffin O, et al. A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need. BMC Cancer, 2020, 20(1): 9.
47. 王天佑, 李单青, 崔永等. 胸外科围手术期肺保护中国专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(9): 835-842.

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Latest ArticlesRisk factors of persistent cough after pneumonectomy: Systematic review and meta-analysis

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