An underestimated cause of chronic cough: The protracted bacterial bronchitis

Filippo, Paola Di; Scaparrotta, Alessandra; Petrosino, Marianna Immacolata; Attanasi, Marina; Pillo, Sabrina Di; Chiarelli, Francesco; Mohn, Angelika

doi:10.4103/atm.atm_12_17

Cited by 20 publications

(25 citation statements)

References 41 publications

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“…CT scan should only be performed following a treatment failure to evaluate the possible presence of underlying bronchiectasis ( 8 ). BAL with a flexible bronchoscope from lower airways should be performed in cases of relapse after three courses of antibiotic; however, the timing is also to be assessed with the parents ( 16 ). According to ERS statement, usually BAL is carried out in the most affected lung area (identified radiologically and/or endoscopically) ( 17 ).…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

et al. 2020

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Chronic cough is defined as a daily cough that persists longer than 4 weeks. Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae , and Moraxella catarrhalis . Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.

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Section: Clinical Features and Diagnosismentioning

confidence: 99%

When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

et al. 2020

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“…Children with PBB were usually young and scarce systemic symptoms, without evidence of sinusitis or ear disease. They typically appeared well, with normal growth and development ( 33 , 34 ).…”

Section: Alternative Diagnosismentioning

confidence: 99%

Asthma: Differential Diagnosis and Comorbidities

et al. 2018

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Childhood asthma remains a multifactorial disease with heterogeneous clinical phenotype and complex genetic inheritance. The primary aim of asthma management is to achieve control of symptoms, in order to reduce the risk of future exacerbations and progressive loss of lung function, which results especially challenging in patients with difficult asthma. When asthma does not respond to maintenance treatment, firstly, the correct diagnosis needs to be confirmed and other diagnosis, such as cystic fibrosis, primary ciliary dyskinesia, immunodeficiency conditions or airway and vascular malformations need to be excluded. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Moreover, all possible risk factors or comorbidities (gastroesophageal reflux, rhinosinusitis, dysfunctional breathing and/or vocal cord dysfunction, obstructive sleep apnea and obesity) should be investigated. At the same time, the possible reasons for poor symptom control need to be find in all modifiable factors which need to be carefully assessed. Non-adherence to medication or inadequate inhalation technique, persistent environmental exposures and psychosocial factors are, currently, recognized as the more common modifiable factors. Based on these premises, investigation and management of asthma require specialist multidisciplinary expertise and a systematic approach to characterizing patients' asthma phenotypes and delivering individualized care. Moreover, since early wheezers are at higher risk of developing asthma, we speculate that precocious interventions aimed at early diagnosis and prevention of modifiable factors might affect the age at onset of wheezing, reduce the prevalence of persistent later asthma and determine long term benefits for lung health.

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“…It is also important to ask about birth history, as the cause of cough in a premature patient may be different than a patient who is born at term; medical problems that cause developmental delays thus predisposing the child to have increased risk of aspiration; and genetic disorders associated with airway abnormalities such as VACTERL syndrome. In children, protracted bacterial bronchitis caused by Streptococcus pneumoniae , Haemophilus influenzae, and Moraxella catarrhalis is described to be very common, so asking about the treatments tried and duration of those treatments is recommended (7, 13). Treatment failure could be due to lack of compliance, inadequate course or inaccurate diagnosis.…”

Section: Pediatric Pulmonologist Perspectivementioning

confidence: 99%

“…In children, protracted bacterial bronchitis caused by Streptococcus pneumoniae , Haemophilus influenzae, and Moraxella catarrhalis is described to be very common (13). …”

Section: Figurementioning

confidence: 99%

Aerodigestive Approach to Chronic Cough in Children

Naime

Batra

Fiorillo

et al. 2018

Curr Treat Options Peds

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Purpose of review: Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings: There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary: There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.

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An underestimated cause of chronic cough: The protracted bacterial bronchitis

Cited by 20 publications

References 41 publications

When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

Asthma: Differential Diagnosis and Comorbidities

Aerodigestive Approach to Chronic Cough in Children

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