ERS statement on protracted bacterial bronchitis in children

Kantar, Ahmad; Chang, Anne B.; Shields, Mike; Marchant, Julie M.; Grimwood, Keith; Grigg, Jonathan; Priftis, Kostas Ν.; Cutrera, Renato; Midulla, Fabio; Brand, Paul; Everard, Mark L.

doi:10.1183/13993003.02139-2016

Cited by 148 publications

(208 citation statements)

References 76 publications

(166 reference statements)

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“…Children with PBB are typically preschool aged and apart from having a cough, appear well . The cough typically worsens with inter‐current viral illnesses but never completely resolves except with appropriate antibiotic therapy …”

Section: Introductionmentioning

confidence: 99%

We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

et al. 2019

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Background and objective Chronic lung disease is prevalent among Australian Aboriginal children. Chronic wet cough is an early marker of disease but often goes undetected. Currently, no studies have examined health practitioner knowledge of chronic wet cough. We set out to examine health practitioner knowledge of chronic wet cough and chronic lung disease in Aboriginal children and to identify barriers and enablers to effective management. Method A qualitative study, gathering data through individual semi‐structured, in‐depth interviews and focus groups to ascertain health practitioner knowledge about management of Aboriginal children with chronic wet cough in a regional Kimberley town and remote community. Results Thirty‐seven health practitioners participated. Key barriers identified were: (i) limited training in assessment and management of chronic wet cough; (ii) prioritization of acute presentations and competing complex chronic conditions; and (iii) normalization of cough in children by health practitioners. Key enablers were: (i) improving practitioners’ knowledge and expertise in managing chronic wet cough; and (ii) health system changes to facilitate longitudinal patient care, improved cultural competence, improved chronic disease management and post‐hospitalization follow‐up. Conclusion Key barriers to effective management of chronic wet cough are limited training in chronic wet cough management combined with competing complexities of both acute and chronic healthcare needs for Aboriginal families. Early detection and management of chronic wet cough in Aboriginal children can be facilitated through health practitioner training, access to standardized management guidelines and a service model that allows longitudinal patient follow‐up and resources to effectively prevent and manage chronic lung disease in children.

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Section: Introductionmentioning

confidence: 99%

We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

et al. 2019

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“…Early recognition leading to the diagnosis and treatment of the precursors of bronchiectasis, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease, can potentially prevent progression to irreversible bronchiectasis …”

mentioning

confidence: 99%

Chronic wet cough in Aboriginal children: It's not just a cough

D'Sylva

Walker

Lane

et al. 2018

J Paediatrics Child Health

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Aim Chronic respiratory disease is common among Aboriginal Australians. Chronic wet cough is an early marker of chronic disease in children but often goes undetected due, in part, to delayed health seeking by families. Currently, no studies have examined the reasons for delayed health seeking for children's chronic cough. To identify the barriers to, and enablers for, seeking medical help for chronic wet cough in Aboriginal children. Methods This was a qualitative study, gathering data through individual semi‐structured, in‐depth interviews and focus groups to ascertain Aboriginal family knowledge, attitudes and beliefs about seeking health care for chronic wet cough in children in a regional Kimberley town, Western Australia between October 2017 and March 2018. Results Forty Aboriginal community members participated. The three key barriers identified were: ‘Cough normalisation’, that is, 70% of participants considered chronic cough normal (with 53% of participants' previous interactions with doctors informing their understanding of chronic cough); the lack of health literacy information; and a sense of disempowerment (belief that no medical action would be taken and inability to challenge doctors). The key expressed enablers were provision of health literacy information and health practitioner training to assess and treat chronic wet cough in children. All participants reported that they would seek help for chronic wet cough once they were informed that it could signify underlying disease. Conclusion Results highlight the need for a culturally appropriate information and education to inform Aboriginal families and their health practitioners of the importance of chronic wet cough in children.

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“…These acute pneumococcal infections and their complications have been studied extensively in children and are reviewed in detail elsewhere . However, much less is known about the role of pneumococci in establishing endobronchial infection and maintaining the chronic pulmonary disorders of protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), and bronchiectasis (see Box for definitions) . These chronic disorders form a continuum of increasing frequency and severity of respiratory symptoms, bacterial infection and airway inflammation that, if untreated, may lead to progressive and irreversible bronchial wall damage and decline in lung function …”

Section: Introductionmentioning

confidence: 99%

Streptococcus pneumoniae and chronic endobronchial infections in childhood

Hare

Leach

Smith‐Vaughan

et al. 2017

Pediatric Pulmonology

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Streptococcus pneumoniae (pneumococcus) is the main cause of bacterial pneumonia worldwide and has been studied extensively in this context. However, its role in chronic endobronchial infections and accompanying lower airway neutrophilic infiltration has received little attention. Severe and recurrent pneumonia are risk factors for chronic suppurative lung disease (CSLD) and bronchiectasis; the latter causes considerable morbidity and, in some populations, premature death in children and adults. Protracted bacterial bronchitis (PBB) is another chronic endobronchial infection associated with substantial morbidity. In some children, PBB may progress to bronchiectasis. Although nontypeable Haemophilus influenzae is the main pathogen in PBB, CSLD and bronchiectasis, pneumococci are isolated commonly from the lower airways of children with these diagnoses. Here we review what is known currently about pneumococci in PBB, CSLD and bronchiectasis, including the importance of pneumococcal nasopharyngeal colonization and how persistence in the lower airways may contribute to the pathogenesis of these chronic pulmonary disorders. Antibiotic treatments, particularly long-term azithromycin therapy, are discussed together with antibiotic resistance and the impact of pneumococcal conjugate vaccines. Important areas requiring further investigation are identified, including immune responses associated with pneumococcal lower airway infection, alone and in combination with other respiratory pathogens, and microarray serotyping to improve detection of carriage and infection by multiple serotypes. Genome wide association studies of pneumococci from the upper and lower airways will help identify virulence and resistance determinants, including potential therapeutic targets and vaccine antigens to treat and prevent endobronchial infections. Much work is needed, but the benefits will be substantial.

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ERS statement on protracted bacterial bronchitis in children

Cited by 148 publications

References 76 publications

We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

Chronic wet cough in Aboriginal children: It's not just a cough

Streptococcus pneumoniae and chronic endobronchial infections in childhood

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