Lung cancer, as the main cause of cancer-related deaths in both males and females, is a
great risk to human health. With the continuous updating of medical equipment and the
gradual popularization of lung cancer screening, the detection rate of pulmonary nodules
has been greatly improved, and surgical treatment is still the main treatment method for
high-risk pulmonary nodules. Pulmonary resection, including wedge resection,
segmentectomy and lobectomy, is the most applicable to early-stage lung cancer diagnoses
and considered the best curative options.
Coughing is a prominent symptom among postoperative complications, with approximately
18%-50% of patients experiencing persistent coughing after surgery. Persistent cough
after pulmonary resection is defined as follows: non-productive cough that occurs more
than 2 weeks after pulmonary resection with stable chest roentgenogram results, no
evidence of postnasal drip syndrome or asthma, and no angiotensin converting enzyme
inhibitor administration. Severe and persistent cough not only increases the difficulty
of postoperative lung function exercise for patients, affects the recovery of the
surgical site, but also affects their daily life and sleep, increases their physiological
and psychological burden, and causes a huge social burden.
However, the reason why cough after pulmonary resection occurs is steal unclear.
CAP can be induced by various factors. According to previous studies, these factors are
classified into four types: surgical factors, anesthetic factors, chemical factors, and
other factors. The majority studies focus on the surgical factors, and have some points
on the risk factors. Several small size studies suggested that mediastinal lymph node
dissection may be an independent risk factor for persistent cough after Some studies
previously reported that some factors, including surgical factors and gastroesophageal
reflux (GER) secondary to the loss of volume after pulmonary resection, may be risky for
persistent cough after pulmonary resection.
Vagus nerves and their branches mainly assume the afferent activities arising from
sensory terminals which located in the lung and airway. And a vast majority of Vagus
nerves and their branches are non-myelinated (C-) fibers.
Under normal or abnormal physiological conditions, the C-fiber locating in the lung and
airway plays an important role in regulating the cardiopulmonary functions.
It is extensively documented that the sensitivity of vagal bronchopulmonary C-fibers can
be enhanced by injury or inflammation of airway mucosa during both acute and chronic
airway diseases. Actually, all afferent C fibers in both the somatosensory and visceral
nervous systems can be stimulated by chemical mediators associated with inflammation.
Some scholars speculate that it may be related to C-type fibers and inflammatory factors
introduced by the vagus nerve. In basic experimental research, DP1, IP, EP1, and EP2
receptors are expressed in C fiber neurons.
This prospective cohort study will describe the incidence of CAP and the trajectory
change in cough severity in patients with thoracoscopic lung resection. The primary
objective of the study is to explore the risk factors for the development of CAP and to
assess the physical, psychological, social, and life burdens of patients with CAP. The
secondary objective is to see if the use of nonsteroidal drugs has an effect on the
development of CAP. This study aims to provide preliminary evidence and guidance on
appropriate treatment of post-pneumonectomy cough and risk factors for persistent cough
and non-steroidal pharmacotherapy for CAP.