Protracted bacterial bronchitis: The last decade and the road ahead

Abstract

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.

Flexible Bronchoscopy Findings in Patient with Protracted Bacterial Bronchitis

“…1 Bazı hastalarda peribronşiyal değişiklikler izlenmektedir. 10,14 Çalışmamızda peribronşiyal değişiklikler %38,7 oranında bulunmuştur.…”

“…8,15,16 Bir diğer açıklama da bu hastalarda yoğun havayolu inflamasyonuna ikincil gelişen trakeomalazidir. 1 Wang ve ark. 3 yaş altı uzamış bakteriyel bronşit tanısı alan çocuklarda %40 oranında bronkomalazi, %13 oranında trakeomalazi olduğunu bildirmişlerdir.…”

“…2 Son yıllarda hastalığın farkındalığı ile uzamış bakteriyel bronşit tanısı alan çocukların sayısında artış olduğu görülmektedir. 1,2 Uzamış bakteriyel bronşit tanısı; altta yatan kronik akciğer hastalığı olmayan bir hastada, dört haftadan uzun süren balgamlı öksürük, bronkoalveolar lavaj kültüründe bakterinin izole edilmesi ve öksürük semptomunun iki haftalık amoksisilin/ klavulanat tedavisine iyi yanıt vermesi ile konulmaktadır. 3 Çocuklardan balgam örneğinin alınmasındaki zorluklara bağlı uzamış bakteriyel bronşitin mikrobiyolojik olarak kanıtlanması zordur, bu nedenle de hastalığın tanı ve tedavisi gecikebilmektedir.…”

Protrahert bakteriell bronkitt hos barn

“…This may lead to children receiving other diagnoses and treatment (8,9). In our experience, many of these children are diagnosed as having asthma, or receive treatment for asthma, but wet cough without variable airway obstruction is seldom asthma (1,10).…”

“…Studies indicate that protracted bacterial bronchitis may be the most common cause of chronic wet cough in pre-school children (1,(5)(6)(7), but awareness of the condition is limited. This may lead to children receiving other diagnoses and treatment (8,9).…”