{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:45:16Z","timestamp":1785527116589,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Bronchoscopy is an invasive procedure, and patient coughing during the examination has been reported to cause significant distress. This study aimed to identify predictors of coughing severity and assess its impact on the procedure during bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Methods: We conducted a prospective study involving 119 consecutive patients with diffuse lung disease who underwent BAL and TBLB at Kyorin University Hospital from April 2019 to December 2023. Cough severity was scored on a scale of 0 to 3, with scores of 0\u20131 considered mild and 2\u20133 considered severe. Multivariate logistic regression analysis was performed to identify factors associated with severe coughing during the procedure. Results: Severe coughing was significantly associated with Grade 2 or higher bleeding (OR 6.230, 95% CI 2.220\u201317.400, p &lt; 0.001), fewer TBLB specimens collected (OR 0.708, 95% CI 0.530\u20130.945, p = 0.019), and pre-procedural dyspnea (OR 2.560, 95% CI 1.110\u20135.870, p = 0.027). Conclusions: Severe coughing during bronchoscopy is associated with increased bleeding and reduced specimen collection. For patients with pre-procedural dyspnea, proactive cough management may improve procedural safety and outcomes.<\/jats:p>","DOI":"10.3390\/jcm14030893","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T07:45:12Z","timestamp":1738136712000},"page":"893","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictors of Severe Coughing and Its Impact on Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Patients with Diffuse Lung Disease: Evaluation of Bronchoscopy Safety"],"prefix":"10.3390","volume":"14","author":[{"given":"Fumi","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0502-8128","authenticated-orcid":false,"given":"Takeshi","family":"Saraya","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozomi","family":"Kurokawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2721-4175","authenticated-orcid":false,"given":"Jumpei","family":"Aso","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Doi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takatora","family":"Akizawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narishige","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kasuga","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaoki","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Nunokawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Nakamoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1088-2954","authenticated-orcid":false,"given":"Mitsuru","family":"Sada","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7140-6273","authenticated-orcid":false,"given":"Keitaro","family":"Nakamoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saori","family":"Takata","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruyuki","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City 181-8611, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/j.1440-1843.2008.01311.x","article-title":"Patient satisfaction with sedation for flexible bronchoscopy","volume":"13","author":"Hirose","year":"2008","journal-title":"Respirology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thoraxjnl-2013-203618","article-title":"British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: Accredited by NICE","volume":"68","author":"Blaikley","year":"2013","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1378\/chest.10-3361","article-title":"American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients","volume":"140","author":"Wahidi","year":"2011","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists (2002). Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology, 96, 1004\u20131017.","DOI":"10.1097\/00000542-200204000-00031"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kobayashi, F., Saraya, T., Oda, M., Sakuma, S., Watanabe, M., Takata, S., Tamura, M., Takakura, H., Nakamoto, K., and Honda, K. (2020). Novel predictive factors for patient discomfort and severe cough during bronchoscopy: A prospective questionnaire analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240485"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kobayashi, F., Saraya, T., Akizawa, T., Abe, T., Takagi, R., Ieki, E., Ishikawa, N., Kurokawa, N., Aso, J., and Nunokawa, H. (2024). Impact of Cough Severity on the Diagnostic Yield of Endobronchial Ultrasonography Transbronchial Biopsy with Guide Sheath: A Retrospective Observational Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020347"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1513\/AnnalsATS.202102-198OC","article-title":"Transbronchial Lung Cryobiopsy in Patients with Interstitial Lung Disease: A Systematic Review","volume":"19","author":"Kheir","year":"2022","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1183\/09031936.03.00298303","article-title":"Combined bronchoalveolar lavage and transbronchial lung biopsy: Safety and yield in ventilated patients","volume":"21","author":"Bulpa","year":"2003","journal-title":"Eur. Respir. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S0344-0338(89)80092-5","article-title":"Diagnostic value of combined bronchoalveolar lavage and transbronchial lung biopsy","volume":"184","author":"Fend","year":"1989","journal-title":"Pathol. Res. Pract."},{"key":"ref_10","first-page":"A5845","article-title":"Safety and Yield of Combined Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Mechanically Ventilated Patients","volume":"183","author":"Jeong","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"00084-2016","DOI":"10.1183\/23120541.00084-2016","article-title":"Iatrogenic bleeding during flexible bronchoscopy: Risk factors, prophylactic measures and management","volume":"3","author":"Bernasconi","year":"2017","journal-title":"ERJ Open Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1164\/rccm.201202-0320ST","article-title":"An official American Thoracic Society clinical practice guideline: The clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease","volume":"185","author":"Meyer","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"384","DOI":"10.4103\/lungindia.lungindia_528_19","article-title":"Comparison of spray catheter with \u201cspray-as-you-go\u201d technique for airway anesthesia during flexible bronchoscopy\u2014A randomized trial","volume":"37","author":"Venkatnarayan","year":"2020","journal-title":"Lung"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/jjco\/hyw083","article-title":"Safety and discomfort during bronchoscopy performed under sedation with fentanyl and midazolam: A prospective study","volume":"46","author":"Minami","year":"2016","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1164\/rccm.202202-0399ST","article-title":"Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline","volume":"205","author":"Raghu","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1164\/ajrccm.165.2.ats01","article-title":"American Thoracic Society\/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias","volume":"165","author":"Travis","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1164\/rccm.201308-1483ST","article-title":"An official American Thoracic Society\/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias","volume":"188","author":"Travis","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1164\/rccm.202005-2032ST","article-title":"Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS\/JRS\/ALAT Clinical Practice Guideline","volume":"202","author":"Raghu","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0140-6736(12)61079-4","article-title":"Interstitial lung disease in connective tissue disorders","volume":"380","author":"Fischer","year":"2012","journal-title":"Lancet"},{"key":"ref_20","first-page":"26","article-title":"The role of transbronchial lung biopsy for the diagnosis of diffuse drug-induced lung disease: A case series of 44 patients","volume":"25","author":"Romagnoli","year":"2008","journal-title":"Sarcoidosis Vasc. Diffuse Lung Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1111\/crj.12318","article-title":"The evaluation of clinical usefulness of transbrochoscopic lung biopsy in undefined interstitial lung diseases: A retrospective study","volume":"11","author":"Han","year":"2017","journal-title":"The Clin. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1111\/crj.13524","article-title":"Is conventional transbronchial lung biopsy out: The evaluation of clinical value in diffuse parenchymal lung disease","volume":"16","author":"Zhou","year":"2022","journal-title":"Clin. Respir. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.chest.2020.01.036","article-title":"Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2019EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transpl."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fujimoto, K., Ishiwata, T., Kasai, H., Terada, J., Shionoya, Y., Ikari, J., Kawata, N., Tada, Y., Tsushima, K., and Tatsumi, K. (2018). Identification of factors during bronchoscopy that affect patient reluctance to undergo repeat examination: Questionnaire analysis after initial bronchoscopy. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0208495"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/MS9.0000000000000180","article-title":"Observational findings of transbronchial lung biopsy in patients with interstitial lung disease: A retrospective study in Aleppo University Hospital","volume":"85","author":"Kashkash","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_27","first-page":"324","article-title":"Transbronchial lung biopsy: An analysis of 530 cases with reference to the number of samples","volume":"52","author":"Descombes","year":"1997","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.alit.2019.05.006","article-title":"Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management","volume":"68","author":"Suzuki","year":"2019","journal-title":"Allergol Int."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Carbone, R.G., Puppo, F., Mattar, E., Roden, A.C., and Hirani, N. (2024). Acute and chronic eosinophilic pneumonia: An overview. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1355247"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/893\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:38:18Z","timestamp":1759919898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030893"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030893","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}