Konsensuspapier zur Evaluation und Therapie des chronischen Hustens in der Pädiatrie

Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough (>4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1β signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.

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Protracted bacterial bronchitis: The last decade and the road ahead

Chang

et al. 2015

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Evaluation and therapy of chronic cough in children

Zacharasiewicz

Eber

Riedler³

et al. 2015

Monatsschr Kinderheilkd

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Chronischer Husten bei Kindern

Zacharasiewicz

2020

Monatsschr Kinderheilkd

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Konsensuspapier zur Evaluation und Therapie des chronischen Hustens in der Pädiatrie

Abstract: Chronic cough needs a detailed history and various differential diagnoses need to be taken in consideration. Children with persistent complaints without a proper diagnosis need to be seen in a center specialized in Pediatric Respiratory Medicine.

Cited by 7 publications

References 70 publications

Protracted bacterial bronchitis: The last decade and the road ahead

Protracted bacterial bronchitis: The last decade and the road ahead

Evaluation and therapy of chronic cough in children

Chronischer Husten bei Kindern

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