Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis

Abstract

The role of persistent and recurrent bacterial infection of the conducting airways (endobronchial infection) in the causation of chronic respiratory symptoms, particularly chronic wet cough, has received very little attention over recent decades other than in the context of cystic fibrosis (CF). This is probably related (at least in part) to the (a) reduction in non-CF bronchiectasis in affluent countries and, (b) intense focus on asthma. In addition failure to characterize endobronchial infections has led to under-recognition and lack of research. The following article describes our current perspective of inter-related endobronchial infections causing chronic wet cough; persistent bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. In all three conditions, impaired muco-ciliary clearance seems to be the common risk factor that provides organisms the opportunity to colonize the lower airway. Respiratory infections in early childhood would appear to be the most common initiating event but other conditions (e.g., tracheobronchomalacia, neuromuscular disease) increases the risk of bacterial colonization. Clinically these conditions overlap and the eventual diagnosis is evident only with further investigations and long term follow up. However whether these conditions are different conditions or reflect severity as part of a spectrum is yet to be determined. Also misdiagnosis of asthma is common and the diagnostic process is further complicated by the fact that the co-existence of asthma is not uncommon. The principles of managing PBB, CSLD and bronchiectasis are the same. Further work is required to improve recognition, diagnosis and management of these causes of chronic wet cough in children.

Paediatrics in Barcelona

“…Equally important is the absence of eosinophils and its implication that the pathologic changes underlying PBB differ from those in asthma. These findings extend current knowledge and suggest that PBB belongs to a continuum, along with chronic suppurative lung disease and bronchiectasis [164]. The absence of severe inflammation within the airway wall might explain why patients with PBB usually respond well to appropriate antibiotic treatment and why the disease is reversible.…”

Lung disease in indigenous children

“…52,53 These conditions overlap and children with CSLD experience similar clinical disease patterns as children with CT-confirmed BE. 49 They also respond similarly to therapies used to treat children with BE. 52,53 Also thirdly, indigenous children living in non-urban centres and children in developing countries have limited access to CT scanning to confirm BE and defining 'irreversibility' requires two CT scans, which is neither safe (increased radiation) nor feasible.…”

“…PBB is characterised by intense airway neutrophilia (40-44%) and elevated markers of neutrophilic inflammation (IL-8, MMP-9) accompanying the bacteria infection with upregulation of innate immunity markers. 48 PBB is likely linked with CSLD and bronchiectasis, 49,50 both of which have a high prevalence among Indigenous children. Early treatment of endobronchial infection can halt on-going infection and inflammation that predispose to chronic airway injury.…”

Double Aortic Arch in Adolescence: A Case Report

“…The diagnosis requires a confirmation of chest CT-scan. Children who have symptoms of bronchiectasis but have not undergone evaluation are referred to as having chronic suppurative lung disease (CSLD) [7] [8]. The pathogenesis of bronchiectasis begins with the presence of acute ulceration in the bronchial wall that occurs after infection of the bronchi, such as bronchopneumonia.…”