CHILDHOOD PNEUMONIA, A COMMON CAUSE OF BRONCHOPULMONARY DISEASE&lt;subtitle&gt;Importance of Prophylaxis and Adequate Therapy&lt;/subtitle&gt;

Finke, W

doi:10.1001/archpedi.1952.02040100053004

Cited by 4 publications

(7 citation statements)

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“…14,15 Analysis of data available in the 1950s led some authorities to conclude at the time that the newer antimicrobial agents had profoundly influenced rates of mortality from pneumonia. 16,17 The greatest reduction in the rate of mortality from pneumococcal pneumonia was among patients who were 12 to 29 years old, with progressively smaller reductions among older patients. 15 We found steep declines in the rates of mortality from pneumonia during the period from 1944 through 1950, which may be attributable to the increased availability of antimicrobial agents; however, we did not find that the new agents led to substantially larger reductions in the number of deaths from lobar pneumonia than in the number from bronchopneumonia.…”

Section: New Antimicrobial Agentsmentioning

confidence: 99%

Mortality from Pneumonia in Children in the United States, 1939 through 1996

Dowell¹,

Kupronis²,

Zell³

et al. 2000

N Engl J Med

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Section: New Antimicrobial Agentsmentioning

confidence: 99%

Mortality from Pneumonia in Children in the United States, 1939 through 1996

Dowell¹,

Kupronis²,

Zell³

et al. 2000

N Engl J Med

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“…Early studies noted the beneficial effects of short-and longterm antibiotics when used to treat the chronic symptoms of both bronchiectasis and chronic bronchitis and prevent and treat exacerbations (31,(109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121)(122). Investigators noted that it took 2 weeks or longer for a significant improvement to be observed and that if there was no improvement by 4 weeks, therapy should be discontinued, which is very similar to recent observations in children with persistent bacterial bronchitis (PBB).…”

Section: Antibiotics and Chronic Bronchitis' Moment In The Sunmentioning

confidence: 99%

“…In the pre-antibiotic era, levels of respiratory morbidity following lower respiratory tract infections were much higher ( 30 , 31 ). A follow-up study of children admitted with an illness consistent with pneumonia found that 25% were still experiencing chronic respiratory symptoms consistent with ‘chronic bronchitis’ some years later ( 30 ).…”

Section: Introductionmentioning

confidence: 99%

“…Investigators noted that it took 2 weeks or longer for a significant improvement to be observed and that if there was no improvement by 4 weeks, therapy should be discontinued, which is very similar to recent observations in children with persistent bacterial bronchitis (PBB). However, it soon became apparent that recurrence of chronic symptoms and exacerbations were all too common on discontinuing the antibiotics, especially amongst those with NTHi ( 31 , 109 , 110 , 114 , 116 , 117 , 123 ), with the suggestion that the organism was able to persist despite antibiotic therapy ( 123 , 124 ) although investigators were uncertain of the mechanism. The idea of dormant ‘persister’ bacteria was well established in 1944 ( 125 ), decades before the recognition of the role of biofilms and IBCs in human diseases ( 126 – 131 ).…”

Section: Introductionmentioning

confidence: 99%

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Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology

Everard,

Priftis,

Koumbourlis

et al. 2024

Front. Pediatr.

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In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to ‘chronic obstructive pulmonary disease’ (COPD) has minimally changed in recent decades while ‘the incidence of bronchiectasis’ is on the rise. The current focus on producing guidelines for these two airway ‘diseases’ has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as ‘diseases’. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed ‘persistent bacterial bronchitis’ (PBB). This condition shares all the same characteristics as ‘chronic bronchitis’, which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.

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“…In the pre-antibiotic era, levels of respiratory morbidity following lower respiratory tract infections were much higher [30,31]. A follow up study of children admitted with an illness consistent will pneumonia found 25% were still experiencing chronic respiratory symptoms consistent with 'chronic bronchitis' some years later [30].…”

Section: Germ Theory Pneumonia and Outcomesmentioning

confidence: 99%

Chronic Bacterial Airways disease: the Pernicious Global Health Challenge Hidden in Plain Sight

Everard¹

2023

Preprint

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This manuscript is aimed at encouraging those interested in biofilms and their effects on microbial communities to view the study of chronic airways disease as one of the most challenging and potentially rewarding areas to focus on. To do this it is necessary to review how we have reached 2023 having made so little progress. It is more than two hundred years ago since the term bronchitis was proposed to describe diseases affecting the airways rather than the respiratory zone of the lungs. The main histological features were described in Laennec’s text of 1819. By the mid C20th it was recognised that the two great drivers of chronic respiratory symptoms were inhaled toxins and chronic bacterial infections. The widespread availability of antibiotics in subsequent years had a dramatic impact on mortality from pneumonia, greatly reduced the prevalence of chronic symptoms after acute lower respiratory tract infections, transformed the lives of many with bronchiectasis and appeared to play a major role in the dramatic fall in prevalence of bronchiectasis. Unfortunately, during the following 70 years the importance of dealing with a chronic bacterial bronchitis was largely forgotten. While two artificial diseases ‘COPD’ and ‘bronchiectasis’ have been the subject of numerous guidelines, chronic bacterial bronchitis has been out in the cold. Antibiotics have in theory been reserved for those with established damage in the form of bronchiolitis and impaired lung function as defined by an arbitrary FEV1/FVC ratio and even then there is a disconnect with a minimum of 2 weeks being prescribed for exacerbations of bronchiectasis and the use of long term inhaled and oral macrolides frequently being advocated while a 5 day course is reserved for an exacerbation in a patient with COPD. The loss of focus on the role of antibiotics has a number of causes – a desire to ration antibiotic as part of ‘antibiotic stewardship’, the potential cost of treatment, the failure to ‘cure’ patients with chronic bronchitis and the difficulty in dealing with a disease whose morbidity at any given time can range from a mild cough and production of phlegm in the morning with no obvious impact on daily function to troublesome cough, sputum production and significant ill health. This was compounded by the vagaries of culture based diagnosis and the observation that more than one potential pathogen was often present. As a result chronic bacterial bronchitis was relegated to the ‘too hard to deal with’ box and many of the lessons of the past were forgotten. Revisiting the field from the perspective of current understanding of bacterial behaviour in biofilms and how these alter the resident microbiota of the airways should ensure that a chronic bacterial bronchitis returns to centre stage in order to minimise respiratory morbidity and mortality. This review charts the history of our understanding and mis-understanding of the role of chronic bacterial bronchitis in airways disease and the pernicious effect of language in helping to ensure that this common and important condition became the elephant in the room. Focusing on the nature of chronic bacterial bronchitis is essential if we are to find ways of identifying it accurately and treat it effectively – new approaches will be extremely slow unless we recognise its importance and the challenges it poses.

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CHILDHOOD PNEUMONIA, A COMMON CAUSE OF BRONCHOPULMONARY DISEASE<subtitle>Importance of Prophylaxis and Adequate Therapy</subtitle>

Cited by 4 publications

References 15 publications

Mortality from Pneumonia in Children in the United States, 1939 through 1996

Mortality from Pneumonia in Children in the United States, 1939 through 1996

Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology

Chronic Bacterial Airways disease: the Pernicious Global Health Challenge Hidden in Plain Sight

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