Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

Abstract

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.

Contemporary Concise Review 2021: COVID‐19 and other respiratory infections

“… 81 Childcare attendance, prior history of chronic cough and age < 2 years increased the risk of PBB following the healthcare presentation for an acute cough illness in children, while a baseline diagnosis of asthma/reactive airways disease or bronchiolitis decreased the risk. 81 Clinicians and parents should be aware of the risk factors and symptoms for PBB. Such knowledge and health‐seeking behaviour can be improved through education with culturally secure health information.…”

“…Protracted bacterial bronchitis (PBB) is a common cause of chronic productive cough in childhood. It is defined as a wet cough of at least 4‐week duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics 81 . Childcare attendance, prior history of chronic cough and age < 2 years increased the risk of PBB following the healthcare presentation for an acute cough illness in children, while a baseline diagnosis of asthma/reactive airways disease or bronchiolitis decreased the risk 81 .…”

“…Positive allergen‐specific IgE at baseline and bronchomalacia were significant predictors of asthma diagnosis 83 . Moraxella catarrhalis was the most common organism (52.4%) identified in a retrospective analysis of 903 children 81 . Ruffles et al performed the first RCT to assess the duration of antibiotic treatment in children with chronic wet cough and suspected PBB, by comparing the clinical cure (cough resolution) by day 28 between 2 and 4 weeks of amoxicillin‐clavulanate.…”

“… 83 Moraxella catarrhalis was the most common organism (52.4%) identified in a retrospective analysis of 903 children. 81 Ruffles et al performed the first RCT to assess the duration of antibiotic treatment in children with chronic wet cough and suspected PBB, by comparing the clinical cure (cough resolution) by day 28 between 2 and 4 weeks of amoxicillin‐clavulanate. By day 28, there was no significant difference in clinical cure between the two groups, but the time to next wet cough exacerbation was significantly longer in the 4‐week group than in the 2‐week group.…”

History Taking as a Diagnostic Tool in Children With Chronic Cough

“…A study (35) that recruited 903 children presenting with acute cough and followed-up for development of chronic cough found that the risk factors for PBB were: childcare attendance [adjusted relative risk (aRR) = 2.32, 95% CI 1.48-3.63], prior history of chronic cough (aRR = 2.63, 95% CI 1.72-4.01), and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42-13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35-2.96). Factors that decreased the risk were baseline diagnoses of asthma/reactive airway disease (aRR = 0.30, 95% CI 0.26-0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06-0.38) (35).…”