Recurrent and/or persistent infection are part of the “vicious cycle” of airway injury associated with bronchiectasis [5]. Although not without initial controversy, PBB is now incorporated into many paediatric chronic cough guidelines [11, 14]. In the Sheffield cohort study,18 36/81 (45%) children were referred for “difficult asthma” and 35 (43%) reported “shortness of breath,” which was attributable to coughing bouts. -. mL−1 BAL with activated neutrophils). It can cause missed days of … The Annals of the American Thoracic Society is an official journal of the American Thoracic Society). Please enable it to take advantage of the complete set of features! PBB causes persistent coughing and disturbed sleep, and affects exercise tolerance, causing significant levels of morbidity. Although protracted bacterial bronchitis (PBB) was only first recognised as a clinical diagnostic entity in 2006 , astute clinicians described PBB-like conditions decades ago and postulated they were part of a pre-bronchiectatic state [1, 3]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Baines KJ, Upham JW, Yerkovich ST, Chang AB, Marchant JM, Carroll M. Chattoraj SS, Ganesan S, Jones AM, Helm JM, Comstock AT, Bright-Thomas R. Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD; TARGET Programme Team. There is a degree of overlap between each of the entities. Chest 2006;129:1132-41. 2013 Jun;14(2):100-5; quiz 106, 137-8. doi: 10.1016/j.prrv.2012.05.002. BE more likely to be present when wet cough unresponsive to 4 wks of ABs. One retrospective study reported tracheo‐bronchomalacia was present in 52/74 (74%) children with PBB.19 However, a prospective study involving 104 children with PBB found that these airway abnormalities were no more common in children with PBB than in those undergoing bronchoscopy for other respiratory indications at a tertiary pediatric hospital (68% vs. 53%, respectively).33 Nevertheless, these proportions are higher than estimates for the general population (1 in 2,100)31 and there is little doubt that children with tracheo‐bronchomalacia have a higher frequency of respiratory infections and symptoms.88, 89. NTHi infection, dysfunctional efferocytosis, and neutrophilic inflammation). Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis. Diagnosis and management of cough executive summary: accp evidence‐based clinical practice guidelines. adults with established bronchiectasis), the pathobiology (e.g. Pediatric pulmonology year in review 2016: Part 2. While antibiotics are generally well tolerated, caregivers should be counseled about possible adverse events (e.g., gastrointestinal complaints, rashes, hypersensitivity) occurring.50 When a child can expectorate, a sputum specimen should be obtained. In both, Streptococcus pneumoniae, Haemophilus influenzae (mostly non-typable, NTHi) and Moraxella catarrhalis were the main bacteria detected in BAL specimens [6, 11]. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. General practice activity in Australia 2003–2004. endstream HHS Pediatr Pulmonol 2008;43:519-31. Azithromycin Prescribing by Respiratory Pediatricians in Australia and New Zealand for Chronic Wet Cough: A Questionnaire-Based Survey. A chronic cough is one that lasts more than 4 weeks. © 2015 Wiley Periodicals, Inc. Its main clinical feature is represented by wet cough that worsens when changing posture and improves after the introduction of antibiotics. Feuchter Husten und protrahierte bakterielle Bronchitis bei Kindern und JugendlichenChronic cough and protracted bacterial bronchitis in children and adolescents. It is postulated that the apoptotic cells may undergo secondary necrosis with pro‐inflammatory effects contributing to the perpetuation of chronic inflammation, infection and tissue damage.78, 79 Support for this hypothesis comes from a small BAL‐based study showing significantly decreased ability of alveolar macrophages to phagocytose apoptotic bronchial cells and NTHi in children with bronchiectasis (n = 55) and PBB (n = 13) compared controls (n = 13).80 For both types of impaired phagocytosis, values in children with PBB were intermediate to those with BE and controls80 (Table 4). In addition to consolidating the preliminary data presented above, other important research questions remain to be answered in this surprisingly common, but poorly recognized pulmonary disorder. PBB‐extended = PBB‐clinical or PBB‐micro, but cough resolves only after 4 weeks of antibiotics. Protracted bacterial bronchitis: bronchial aspirate versus bronchoalveolar lavage findings: a single-centre retrospective study. Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. The Annals of the American Thoracic Society is an official journal of the American Thoracic Society). •Determining the burden of disease (e.g., incidence, prevalence, QoL, economic cost) in the general community, •Ascertaining the long‐term outcomes of children with recurrent and non‐recurrent episodes, •Clarifying whether children with PBB‐extended have different long term outcomes, •Identifying the underlying developmental and pathobiologic mechanisms, •Uncovering host biological susceptibility factors, including the role of airway malacia, •Describing the frequency and mechanisms of virus‐induced PBB episodes, •Detecting a biomarker that can predict response to antibiotics and risk of recurrence, •Determining if longer courses of antibiotics of up to 4 weeks duration reduce recurrences, •Performing multicenter intervention trials to help identify those requiring longer antibiotic courses of up to 4 weeks evaluating the role of prophylactic antibiotics in patients with frequent (>3 annually) recurrences, but still lacking disease pointers and evidence of bronchiectasis, receptor for advanced glycation end‐products, soluble receptor for advanced glycation end‐products. Three Clinically Distinct Chronic Pediatric Airway Infections Share a Common Core Microbiota. 2016 Mar;51(3):225-42. doi: 10.1002/ppul.23351. Nevertheless, there is little doubt that more in-depth studies and long-term cohort studies are needed.

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