Paediatric chronic suppurative lung disease

clinical characteristics and outcomes

V Goyal, Keith Grimwood, Julie Marchant, Ian Brent Masters, Anne Chang

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13–52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4–6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8–14). All were cough-free at follow-up.

    Conclusion: The children’s BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent.
    Original languageEnglish
    Pages (from-to)1077-1084
    Number of pages8
    JournalEuropean Journal of Pediatrics
    Volume175
    Issue number8
    DOIs
    Publication statusPublished - Aug 2016

    Fingerprint

    Lung Diseases
    Cough
    Pediatrics
    Anti-Bacterial Agents
    Bronchoalveolar Lavage
    Hospitalization
    Thorax
    Tracheomalacia
    Bronchiectasis
    Cefotaxime
    Ceftriaxone
    Bronchitis
    Respiratory Sounds
    Bronchoalveolar Lavage Fluid
    Haemophilus influenzae
    Bronchoscopy
    Inpatients
    Therapeutics

    Cite this

    Goyal, V ; Grimwood, Keith ; Marchant, Julie ; Masters, Ian Brent ; Chang, Anne. / Paediatric chronic suppurative lung disease : clinical characteristics and outcomes. In: European Journal of Pediatrics. 2016 ; Vol. 175, No. 8. pp. 1077-1084.
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    title = "Paediatric chronic suppurative lung disease: clinical characteristics and outcomes",
    abstract = "We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13–52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4–6.5). On chest examination, seven (31 {\%}) children had auscultatory crackles. At bronchoscopy, 9 (41 {\%}) had tracheomalacia, 18 (86 {\%}) demonstrated airway neutrophilia (>15 {\%}) and 12 (57 {\%}) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8–14). All were cough-free at follow-up.Conclusion: The children’s BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent.",
    author = "V Goyal and Keith Grimwood and Julie Marchant and Masters, {Ian Brent} and Anne Chang",
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    Paediatric chronic suppurative lung disease : clinical characteristics and outcomes. / Goyal, V; Grimwood, Keith; Marchant, Julie; Masters, Ian Brent; Chang, Anne.

    In: European Journal of Pediatrics, Vol. 175, No. 8, 08.2016, p. 1077-1084.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Grimwood, Keith

    AU - Marchant, Julie

    AU - Masters, Ian Brent

    AU - Chang, Anne

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