Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer.

INTRODUCTION: Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue. METHODS: Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs. RESULTS: Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group. CONCLUSION: Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance.

BACKGROUND: The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. CASE PRESENTATION: A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. CONCLUSIONS: This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.

Intracuff Lidocaine and Postoperative Throat Mucosal Injuries: An Evidence-based Review.

PURPOSE: Examine the effectiveness of using intracuff lidocaine to minimize postoperative complications. DESIGN: Systematic review. METHODS: This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. PubMed, CINAHL, Cochrane, Google Scholar, and gray literature databases were searched to obtain eligible studies and minimize selection bias. The Johns Hopkins Nursing Evidence-Based Practice Model was used to appraise the level of evidence for the varying studies. Only randomized controlled trials (RCT) and systematic reviews with meta-analyses of RCTs were included in the review. FINDINGS: Three RCTs and three systematic reviews with meta-analyses incorporating a total of 2,337 patients were included in this review. Intracuff lidocaine (alkalinized and nonalkalinized) had the lowest incidence of postoperative sore throat in the early and late postoperative periods compared to intracuff air or intracuff saline. Furthermore, the evidence suggested that the use of intracuff lidocaine reduced postextubation cough and the incidence of hoarseness but had little or no effect on dysphagia. All studies were Level 1 and Grade A, indicating clinically solid evidence in analyzing intracuff lidocaine's effect on all outcomes measured. CONCLUSIONS: The current literature suggests the feasibility of using intracuff lidocaine as an effective method to reduce the incidence of postoperative sore throat, postextubation cough, and hoarseness. The implications to practice include improving the norm of postoperative throat mucosal injuries by implementing an evidence-based practice intervention of intracuff lidocaine.

Comparison of postoperative cough-related quality of life and recovery between sublobectomy and lobectomy for early-stage non-small cell lung cancer patients: a longitudinal study.

BACKGROUND: Cough is a common complication after pulmonary surgery. Previous studies lacked a standard measure to assess postoperative cough-related quality of life and recovery. The purpose of this study is to compare postoperative cough regarding changes in health-related quality of life (HRQOL) and recovery trajectory between video-assisted thoracic surgery (VATS) lobectomy and sublobectomy (segmentectomy or wedge resection) for early-stage non-small cell lung cancer (NSCLC) patients via the Leicester Cough Questionnaire in Mandarin Chinese (LCQ-MC). METHODS: Overall, 156 patients with NSCLC underwent either VATS lobectomy or VATS sublobectomy; LCQ-MC was used to report the impact of postoperative cough on HRQOL for 6 months after surgery. The total scores of LCQ-MC range from 3 to 21, with a higher score indicating better health. Recovery from postoperative cough was defined as LCQ-MC scores returning to preoperative levels. The sensitivity of LCQ-MC to changes in postoperative cough recovery over time was evaluated via its ability to distinguish between surgery types. RESULTS: The VATS sublobectomy group reported significantly higher mean LCQ-MC scores at 1 month after surgery, but no significant difference postoperatively at 3 and 6 months after surgery, and returned to preoperative physical (69 vs. 99 days), psychological (67 vs. 99 days), social (50 vs. 98 days) and total (69 vs. 99 days) scores faster than the VATS lobectomy group (all p < 0.05). CONCLUSION: VATS sublobectomy had generally better HRQOL and faster recovery of postoperative cough than VATS lobectomy. In addition, the LCQ-MC performed satisfactorily in describing the longitudinal changes in postoperative cough.

Incidence and risk factor for short term postoperative cough after thyroidectomy.

BACKGROUND: The prevalence of potential risk factors for postoperative cough after thyroidectomy remain unknown. The current study aimed to research postoperative cough in patients undergoing thyroid surgery prospectively. METHODS: Adult patients who underwent primary thyroid surgery were selected prospectively. Data regarding age, sex, BMI, pathology and surgical procedure were collected and analyzed. The Leicester Cugh Questionnaire (LCQ) was required to be completed by all patients before operation, 2 weeks and 4 weeks after operation. RESULTS: There were 1264 patients enrolled in total. Eleven patients with vocal cord paralysis were excluded. In patients with benign disease, postoperative cough occurred in 61 patients, with an prevalence rate of 17. 0% compared to an prevalence rate of 33.1% in patients with malignant disease; the difference was significant. For benign patients, the factors of smoking and operation time were independently related to the occurrence of postoperative cough. For malignant patients, the factors of smoking, operation time, operation extent, and the number of positive nodes at level 6 were independently related to the occurrence of postoperative cough. There was no significant difference regarding the LCQ score in patients with benign or malignant disease at the preoperative and the postoperative 4-week time periods. Patients with malignant disease had a significantly lower LCQ score than patients with benign disease at the postoperative 2-week time point (p = 0.004). CONCLUSIONS: Patients undergoing thyroid cancer surgery had a higher incidence of postoperative cough and were also associated with a decreased cough-related quality of life. The factors of smoking and operation time were the most important predictors for postoperative cough after thyroidectomy.

[Effect of transcutaneous electrical acupoint stimulation on postoperative cough in lung cancer patients undergoing video-assisted thoracoscopic surgery].

OBJECTIVE: To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) for alleviating postoperative cough in lung cancer patients undergoing video-assisted thoracoscopic surgery. METHODS: A total of 110 patients with lung cancer undergoing video-assisted thoracoscopic surgery were randomly divided into a TEAS group (55 cases, 2 cases dropped out) and a sham-TEAS group (55 cases, 4 cases dropped out). In the TEAS group, TEAS was delivered 30 min before anesthesia and on day 1 to day 4 after operation separately, with disperse-dense wave, in frequence of 2 Hz/100 Hz. The acupoints included Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23), Hegu (LI 4), Lieque (LU 7) and Taixi (KI 3) on the both sides. In the sham-TEAS group, at the same time points and same acupoints as the TEAS group, the electrode pads were attached to the acupoints, but without electric stimulation. The interventions were given 30 min each time, once daily in the two groups. The incidence of cough and the scores of visual analogue scale (VAS) for cough on the first day (T1), the third day (T2), the fifth day (T3), 1 month (T4) and 3 months (T5) after operation, as well as the scores of the Leicester cough questionnaire (LCQ) on T4 and T5 were compared between the two groups; the contents of serum C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were detected before surgery (T0) and at T1, T2 and T3. The first flatus time, the first defecation time, the first ambulation time, the postoperative hospital day and the incidence of postoperative nausea and vomiting were compared between the two groups. RESULTS: Compared with the sham-TEAS group, the cough incidence at T3 and cough VAS scores at T1 to T5 were lower in the TEAS group (P<0.05, P<0.01), and the LCQ scores at T4 and T5 were higher (P<0.05). The serum contents of CRP, IL-6 and TNF-αat T1 to T3 in the TEAS group were lower than those of the sham-TEAS group (P<0.01). The first flatus time, the first defecation time and the first ambulation time were earlier (P<0.05, P<0.01); and the postoperative hospital day was shorter (P<0.05) and the incidence of postoperative nausea and vomiting was lower (P<0.05) in the TEAS group when compared with those of the sham-TEAS group. CONCLUSION: TEAS relieves cough in lung cancer patients undergoing video-assisted thoracoscopic surgery, improves quality of life and promotes the early postoperative recovery.

Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression.

OBJECTIVES: To evaluate the effectiveness of peri-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients. DESIGN: A systematic review with meta-analysis and meta-regression. SETTING: Elective surgery under general anesthesia in operating rooms. MAIN OUTCOME MEASURES: Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness. RESULTS: Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20-0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16-0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: -0.50, 95 % CI: -0.81 to -0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02-0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15-0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation. CONCLUSION: Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness. IMPLICATIONS FOR CLINICAL PRACTICE: Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery. SYSTEMATIC REVIEW PROTOCOL: The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).

Extubation by supraglottic airway after lobectomy prevents cough-associated air leaks and prolonged coughing or sore throat.

OBJECTIVES: Double-lumen endobronchial tubes (DLTs) are essential for differential lung ventilation during pulmonary lobectomy, but they are more rigid, longer, larger in diameter and irritable. Coughing at extubation sometimes causes airway and lung injury, which causes severe air leaks, prolonged cough and sore throat. We examined the prevalence of cough-associated air leaks at extubation and postoperative cough or sore throat after lobectomy and evaluated the efficacy of supraglottic airway (SGA) in preventing these complications. METHODS: Patient characteristics and operative and postoperative factors data were collected from patients who underwent pulmonary lobectomy between January 2013 and March 2022. After propensity score matching, these data were compared between the SGA and DLT groups. RESULTS: A total of 1069 patients with lung cancer (SGA, 641; DLTs, 428) were enrolled and coughing at extubation occurred in 100 (23.4%) patients in the DLT group, 65 (65.0%) showed increased cough-associated air leaks at extubation and 20 (30.8%) showed prolonged air leaks. Coughing at extubation occurred in 6 (0.9%) in the SGA group. In 193 patients from each group after propensity score matching, coughing at extubation and the associated air leak increase were significantly lower in the SGA group. Visual analogue scale of postoperative cough and sore throat on postoperative days 2, 7 and 30 were significantly lower in the SGA group. CONCLUSIONS: SGA is effective and safe for preventing cough-associated air leaks and prolonged postoperative cough or sore throat at extubation following pulmonary lobectomy.

Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients.

BACKGROUND: To date, postoperative intractable cough (PIC) has not received adequate attention, and the complex perioperative factors when performing pulmonary resection often prevent researchers from addressing this issue. This study aimed to investigate the clinicopathological and radiographic indicators related to PIC in lung cancer patients. METHODS: In all, 112 patients who had had right upper lobectomy for primary lung cancer from January 2019 to December 2020 were retrospectively reviewed. We collected data via the electronic medical database of our department. Bronchial morphological features were investigated comprehensively via three-dimensional chest computer tomography reconstruction images. RESULTS: During outpatient follow-up visits, 41 (36.6%) patients complained about persistent dry cough after surgery. Compared with the non-cough group, patients in the refractory cough group showed significant differences in smoking history, right upper lobe stump length, changes of right bronchus intermedius (RBI) diameter, changes of right lower lobe (RLL) basal bronchus diameter, changes of RBI/RLL bronchial angle, and bronchial kink. However, according to multivariable regression analysis, stump length, bronchial kink, and diameter change of the right lower lobe basal bronchus were independently associated with postoperative refractory cough. A nebulization drug was prescribed for the 41 patients diagnosed with PIC, and 33 (80.5%) patients had improved by the next visit. CONCLUSIONS: After right upper lobectomy, the morphology of the remaining bronchial tree in the residual lung changed significantly. The bronchial morphological alterations were independent risk factors for PIC.

Lymph Node Dissection Is a Risk Factor for Short-Term Cough after Pulmonary Resection.

Cough is a common complication after pulmonary resection. However, the factors associated with cough that develop after pulmonary resection are still controversial. In this study, we used the Simplified Cough Score (SCS) and the Leicester Cough Questionnaire (LCQ) score to investigate potential risk factors for postoperative cough. Between January 2017 and June 2021, we collected the clinical data of 517 patients, the SCS at three days after surgery and the LCQ at two weeks and six weeks after surgery. Then, univariate and multivariate analyses were used to identify the independent risk factors for postoperative cough. The clinical baseline data of the cough group and the non-cough group were similar. However, the cough group had longer operation time and more blood loss. The patients who underwent lobectomy were more likely to develop postoperative cough than the patients who underwent segmentectomy and wedge resection, while the patients who underwent systematic lymph node dissection were more likely to develop postoperative cough than the patients who underwent lymph node sampling and those who did not undergo lymph node resection. When the same lymph node management method was applied, there was no difference in the LCQ scores between the patients who underwent wedge resection, lobectomy and segmentectomy. The lymph node resection method was an independent risk factor for postoperative cough (p < 0.001). Conclusions: Lymph node resection is an independent risk factor for short-term cough after pulmonary resection with video-assisted thoracoscopic surgery, and damage to the vagus nerve and its branches (particularly the pulmonary branches) is a possible cause of short-term cough. The mechanism of postoperative cough remains to be further studied.

Validation of the simplified cough symptom score in non-small cell lung cancer patients after surgery.

BACKGROUND: The simplified Cough Symptom Score (sCSS) is a practical and simple tool for measuring cough severity. However, the sCSS is a consensus of experts, and has not been strictly validated among the non-small cell lung cancer (NSCLC) patients. We used the sCSS and investigated the validity, reliability, and repeatability of this instrument. METHODS: A total of 219 NSCLC patients completed the sCSS, Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC) and cough Visual Analog Scale (VAS). 60 patients completed the LCQ and Global Rating of Change (GRC) at follow-up visits after 2-4 weeks. Concurrent validity, internal consistency, and repeatability were assessed. RESULTS: Analyses of concurrent validity showed significant correlations between the sCSS and the LCQ-MC (r = - 0.356 to - 0.580) and cough VAS (r = 0.555). The correlation of the nighttime score with the LCQ-MC and cough VAS was more closely than that of the daytime score (r = - 0.364 to - 0.545 and r = 0.502 vs. r = - 0.233 to - 0.449 and r = 0.450). Internal consistency was acceptable (Cronbach's α of 0.74-0.90). The internal consistency of the sCSS between the nighttime and daytime scores was 0.428. The repeatability was high (intraclass correlation coefficients of 0.760). CONCLUSION: The sCSS is a reliable, valid instrument for assessing postoperative cough in NSCLC patients.

Effects of preserving the bronchial artery on cough after thoracoscopic lobectomy.

BACKGROUND: The purpose of this prospective study was to explore the influence of both preoperative three-dimensional (3D) reconstruction and intraoperative preservation of the bronchial artery (BA) on postoperative cough after thoracoscopic lobectomy. METHODS: A total of 60 patients who had received a combination of thoracoscopic lobectomy and systematic lymph node dissection were included in this study. They were divided into two groups, namely the BA preservation group (Group A), and conventional surgical treatment group (Group B). In group A, we used Exoview software for 3D reconstruction of the BA before the operation and the BA was preserved during the operation. 3D reconstruction of the BA was not performed before surgery in group B. The incidence of postoperative cough, the Mandarin Chinese version of the Leicester cough questionnaire (LCQ-MC), physiological, psychological and social dimensions and total score of the two groups were compared and analyzed. RESULTS: The scores and total scores of LCQ-MC in group B were lower than those in group A one and two months after surgery. There were significant differences between the two groups in physiological and psychological dimensions and total scores (p < 0.05), but there was no significant difference in social dimension between the two groups (p > 0.05). The incidence of postoperative cough in group A (16.7%) was lower than that in group B (30%), while the difference was not statistically significant (p = 0.222). CONCLUSIONS: Preoperative 3D reconstruction and intraoperative preservation of the BA can reduce the severity of postoperative cough.

Effect of different thoracic anesthesia on postoperative cough.

BACKGROUND: The objective of the study is to retrospectively analyze the cough status after double lumen tube (DLT) and spontaneous respiration thoracic anesthesia, to compare the degree of influence of anesthesia and surgical factors, and to investigate whether spontaneous respiration anesthesia can reduce the incidence of cough. METHODS: Postoperative follow-ups were performed on 1,162 patients from July 2011 to December 2015 who meet the selected conditions, whose surgical approach is limited to VAST bullectomy, wedge resection, segmentectomy, or lobectomy. Patients' probability of cough in 1st day (T1), 2nd days (T2), 3rd days (T3), 1st month (T4), 3rd months (T5), 6th months (T6) and 12th months (T7) after thoracoscopic surgery were recorded, as well as the Leicester cough questionnaire (LCQ) survey results, visual cough score (VAS), and cough symptom scores. All cases were divided into double-lumen endotracheal tubes anesthesia group (group T, n=925 cases) and spontaneous respiratory anesthesia group (group S, n=456 cases), and group S was further divided into intravenous composite intercostal nerve block anesthesia group (group SB, n=157 cases) and intravenous combined epidural anesthesia group (group SE, n=299 cases). RESULTS: The probability of cough decreases with the increasing of postoperative time (P<0.05). The probability of cough is similar between group SE and group SB (P>0.05). The probability of cough in group T is significantly higher than other groups at any time point (P<0.05). In group T, the symptom of cough is the most severe, the scores of physiological, psychological, and social parts of LCQ are the lowest, and the VAS score is the highest (P<0.05), but all these are similar in group SE and group SB (P>0.05). The duration of antibiotic application, the days of chest drainage tube indwelling, and the days of hospital stay are all lower in group S than in group T (P<0.05). CONCLUSIONS: There is a correlation between pulmonary surgery and postoperative cough. The probability of postoperative cough is higher in the more invasive patients. The probability of coughing is approximately 27% to 36% at 3 months after surgery, and approximately 2.6% to 7.9% in one year after surgery. The combination of surgery and anesthesia methods increases the probability of cough from 48.9% to 65.1% at 3 months after surgery, and about 20.5% to 22.8% in 1 year after surgery. Spontaneous respiration anesthesia can significantly reduce the probability of cough, improve postoperative recovery, and improve postoperative quality of life.