Protracted bacterial bronchitis

The last decade and the road ahead

Anne B. Chang, John W. Upham, I. Brent Masters, Gregory R. Redding, Peter G. Gibson, Julie M. Marchant, Keith Grimwood

Research output: Contribution to journalArticleResearchpeer-review

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. Pediatr Pulmonol. 2016;51:225-242.

Original languageEnglish
Pages (from-to)225-242
Number of pages18
JournalPediatric Pulmonology
Volume51
Issue number3
DOIs
Publication statusPublished - 1 Mar 2016

Fingerprint

Bronchitis
Cough
Bronchiectasis
Bronchoalveolar Lavage
Anti-Bacterial Agents
Clavulanic Acid
Neutrophil Infiltration
Amoxicillin
Haemophilus influenzae
Primary Care Physicians
Bronchoscopy
Sputum
Interleukin-1
Phagocytosis
Innate Immunity
Referral and Consultation
Quality of Life
Morbidity
Gene Expression
Recurrence

Cite this

Chang, A. B., Upham, J. W., Masters, I. B., Redding, G. R., Gibson, P. G., Marchant, J. M., & Grimwood, K. (2016). Protracted bacterial bronchitis: The last decade and the road ahead. Pediatric Pulmonology, 51(3), 225-242. https://doi.org/10.1002/ppul.23351
Chang, Anne B. ; Upham, John W. ; Masters, I. Brent ; Redding, Gregory R. ; Gibson, Peter G. ; Marchant, Julie M. ; Grimwood, Keith. / Protracted bacterial bronchitis : The last decade and the road ahead. In: Pediatric Pulmonology. 2016 ; Vol. 51, No. 3. pp. 225-242.
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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. Pediatr Pulmonol. 2016;51:225-242.",
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Chang, AB, Upham, JW, Masters, IB, Redding, GR, Gibson, PG, Marchant, JM & Grimwood, K 2016, 'Protracted bacterial bronchitis: The last decade and the road ahead', Pediatric Pulmonology, vol. 51, no. 3, pp. 225-242. https://doi.org/10.1002/ppul.23351

Protracted bacterial bronchitis : The last decade and the road ahead. / Chang, Anne B.; Upham, John W.; Masters, I. Brent; Redding, Gregory R.; Gibson, Peter G.; Marchant, Julie M.; Grimwood, Keith.

In: Pediatric Pulmonology, Vol. 51, No. 3, 01.03.2016, p. 225-242.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Marchant, Julie M.

AU - Grimwood, Keith

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Chang AB, Upham JW, Masters IB, Redding GR, Gibson PG, Marchant JM et al. Protracted bacterial bronchitis: The last decade and the road ahead. Pediatric Pulmonology. 2016 Mar 1;51(3):225-242. https://doi.org/10.1002/ppul.23351