Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis

Danielle F. Wurzel, Julie M. Marchant, Stephanie T. Yerkovich, John W. Upham, Helen L. Petsky, Heidi Smith-Vaughan, Brent Masters, Helen Buntain, Anne B. Chang

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    Abstract

    Background: Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of bronchiectasis and (2) identify risk factors for bronchiectasis and recurrent episodes of PBB. 

    Methods: One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of bronchiectasis. 

    Results: Of 161 children with PBB (66% boys), 13 were diagnosed with bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) (P =.013) and recurrent episodes of PBB (P =.003). H influenzae infection conferred a more than seven times higher risk of bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P =.009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae. No risk factors for recurrent PBB were identified. 

    Conclusions: PBB is associated with a future diagnosis of bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.

    Original languageEnglish
    Pages (from-to)1101-1108
    Number of pages8
    JournalChest
    Volume150
    Issue number5
    DOIs
    Publication statusPublished - Nov 2016

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    Wurzel, D. F., Marchant, J. M., Yerkovich, S. T., Upham, J. W., Petsky, H. L., Smith-Vaughan, H., Masters, B., Buntain, H., & Chang, A. B. (2016). Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis. Chest, 150(5), 1101-1108. https://doi.org/10.1016/j.chest.2016.06.030