Background: Current guidelines on the management of chronic cough do not provide recommendations for the operation of specialist cough clinics. The objective of the present study was to develop expert consensus on goals and standard procedures for specialist cough clinics.Methods: We undertook a modified Delphi process, whereby initial statements proposed by experts were categorised and presented back to panellists over two ranking rounds using an 11-point Likert scale to identify consensus.Results: An international panel of 57 experts from 19 countries participated, with consensus reached on 15 out of 16 statements, covering the aims, roles and standard procedures of specialist cough clinics. Panellists agreed that specialist cough clinics offer optimal care for patients with chronic cough. They also agreed that history taking should enquire as to cough triggers, cough severity rating scales should be routinely used, and a minimum of chest radiography, spirometry and measurements of type 2 inflammatory markers should be undertaken in newly referred patients. The importance of specialist cough clinics in promoting clinical research and cough specialty training was acknowledged. Variability in healthcare resources and clinical needs between geographical regions was noted.Conclusions: The Delphi exercise provides a platform and guidance for both established cough clinics and those in planning stages.

Background: Refractory chronic cough and unexplained chronic cough pose significant clinical challenges, impairing patients’ quality of life. However, a precise definition of refractory chronic cough remains elusive. This study aimed to assess the prevalence of refractory and unexplained chronic cough among patients referred to our cough centre and to analyse the prevalence of refractory chronic cough relative to its definition.Methods: This prospective cohort study included all patients who were diagnosed at a cough clinic between 2018 and 2022. The response to therapy was measured based on reduction in cough severity (viaa visual analogue scale) and improvement in cough-related quality of life (viathe Leicester Cough Questionnaire). Refractory chronic cough was defined as persistent cough severity, with no or minimal improvement (change in visual analogue scale <30 mm) after two or more treatment attempts and cough severity ≥40 out of 100 mm on the visual analogue scale.Results: Of 201 patients treated for chronic cough, only three (1.5%) were diagnosed with unexplained chronic cough. Among 166 patients monitored for therapy response, 71 (42.8%) experienced a cough severity reduction of ≥30 mm on the visual analogue scale, while 100 (60.2%) showed an improvement of ≥1.5 points on the Leicester Cough Questionnaire. Based on the basic refractory chronic cough definition, 51 of 166 patients (30.7%) were diagnosed with refractory chronic cough. If applying stricter criteria (persistent severe cough (≥40 mm on the visual analogue scale), insufficient therapy response (<30 mm reduction on the visual analogue scale) and <1.5-point improvement on the Leicester Cough Questionnaire), 45 of 166 patients (27.1%) would be diagnosed with refractory chronic cough.Conclusions: Refractory chronic cough is common in patients referred to cough clinics. The prevalence of refractory chronic cough differs slightly depending on the diagnostic criteria. Therefore, the definition of refractory chronic cough used in routine practice needs to be clarified.

Radiological and nuclear medicine methods play a fundamental role in the diagnosis and staging of patients with lung cancer. Imaging is essential in the detection, characterisation, staging and follow-up of lung cancer. Due to the increasing evidence, low-dose chest computed tomography (CT) screening for the early detection of lung cancer is being introduced to the clinical routine in several countries. Radiomics and radiogenomics are emerging fields reliant on artificial intelligence to improve diagnosis and personalised risk stratification. Ultrasound- and CT-guided interventions are minimally invasive methods for the diagnosis and treatment of pulmonary malignancies. In this review, we put more emphasis on the new developments in the imaging of lung cancer.

Contrast-enhanced computed tomography (CECT) and positron emission tomography with 18-FDG (FDG-PET/CT) are used to identify malignant solitary pulmonary nodules. The aim of the study was to evaluate the accuracy of CECT and FDG-PET/CT in diagnosing the etiology of solitary pulmonary nodule (SPN). Eighty patients with newly diagnosed SPN >8 mm were enrolled. The patients were scheduled for either or both, CECT and FDG-PET/CT. The nature of SPN (malignant or benign) was determined either by its pathological examination or radiological criteria. In 71 patients, the etiology of SPN was established and these patients were included in the final analysis. The median SPN diameter in these patients was 13 mm (range 8–30 mm). Twenty-two nodules (31%) were malignant, whereas 49 nodules were benign. FDG-PET/CT was performed in 40 patients, and CECT in 39 subjects. Diagnostic accuracy of CECT was 0.58 (95% confidence interval [CI] 0.41–0.74). The optimal cutoff level discriminating between malignant and benign SPN was an enhancement value of 19 Hounsfield units, for which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CECT were 100%, 37%, 32%, and 100%, respectively. Diagnostic accuracy of FDG-PET/CT reached 0.9 (95% CI 0.76–0.9). The optimal cutoff level for FDG-PET/CT was maximal standardized uptake value (SUV max) 2.1. At this point, the sensitivity, specificity, PPV, and NPV were 77%, 92%, 83%, and 89%, respectively. The diagnostic accuracy of FDG-PET/CT is higher than that of CECT. The advantage of CECT is its high sensitivity and negative predictive value.