The Likelihood of Preventing Respiratory Exacerbations in Children and Adolescents with either Chronic Suppurative Lung Disease or Bronchiectasis

Abstract

Chronic suppurative lung disease (CSLD) and bronchiectasis in children and adolescents are important causes of respiratory morbidity and reduced quality of life (QoL), also leading to subsequent premature death during adulthood. Acute respiratory exacerbations in pediatric CSLD and bronchiectasis are important markers of disease control clinically, given that they impact upon QoL and increase health-care-associated costs and can adversely affect future lung functioning. Preventing exacerbations in this population is, therefore, likely to have significant individual, familial, societal, and health-sector benefits. In this review, we focus on therapeutic interventions, such as drugs (antibiotics, mucolytics, hyperosmolar agents, bronchodilators, corticosteroids, non-steroidal anti-inflammatory agents), vaccines and physiotherapy, and care-planning, such as post-hospitalization management and health promotion strategies, including exercise, diet, and reducing exposure to environmental toxicants. The review identified a conspicuous lack of moderate or high-quality evidence for preventing respiratory exacerbations in children and adolescents with CSLD or bronchiectasis. Given the short- and long-term impact of exacerbations upon individuals, their families, and society as a whole, large studies addressing interventions at the primary and tertiary prevention phases are required. This research must include children and adolescents in both developing and developed countries and address long-term health outcomes.

The Incidence and Short-term Outcomes of Acute Respiratory Illness with Cough in Children from a Socioeconomically Disadvantaged Urban Community in Australia: A Community-Based Prospective Cohort Study

“…There is currently limited evidence for interventions to prevent recurrent ARI and exacerbations of chronic lung disease in children ( 47 ). Hence focusing on strategies to minimize the risk of disease and optimize early recognition and management of chronic cough are likely important, as is ongoing, high-quality research.…”

Bronchiectasis - Exercise as Therapy (BREATH): Rationale and Study Protocol for a Multi-center Randomized Controlled Trial

“…Pediatric BE is a signi cant contributor to global mortality, morbidity and health-care utilization yet there is a paucity of research on non-pharmaceutical interventions that aim to improve HRQoL and impact disease progression for this population [1][2][3]6]. It has been established that children with BE have delayed FMS pro ciency leading to insu cient physical activity for health bene t [19].…”

“…5 Menzies School of Health Research, Darwin, NT, Australia. 6 George Institute for Global Health, Sydney, NSW, Australia. 7 Gri th University, QLD, Australia.…”

“…Children with BE regularly experience exacerbations of their condition (increased wetness and severity of cough, breathlessness, chest pain, and/or wheeze) resulting in frequent hospitalizations and decreased of health-related quality of life (HRQoL) [2,6]. Prevalence data in children are scarce however, a recent review of the epidemiology of CLSD estimated the prevalence of BE to range from 0.2 to 15 cases per 100,000 [7].…”

“…A recent meta-analysis of the effects of exercise training on physical and psychosocial health in children with chronic respiratory disease identi ed no published studies investigating the impact of therapeutic exercise in this population [12]. Therapeutic exercise may bene t children with BE by reducing the frequency and severity of acute exacerbations -an independent predictor of long-term decline in lung function [6]. A randomized controlled trial (RCT) evaluating the effects of an eight-week exercise program in adults with BE reported signi cant reductions in the number of acute exacerbations over a 12-month period [13].…”