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

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 objec...

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Published in:Chest Vol. 150; no. 5; p. 1101
Main Authors: Wurzel, Danielle F, Marchant, Julie M, Yerkovich, Stephanie T, Upham, John W, Petsky, Helen L, Smith-Vaughan, Heidi, Masters, Brent, Buntain, Helen, Chang, Anne B
Format: Journal Article
Language:English
Published: United States 01.11.2016
Subjects:
Bacterial Infections - microbiology
Bronchiectasis - microbiology
Bronchitis - microbiology
Bronchoalveolar Lavage Fluid - microbiology
Child
Child, Preschool
Female
Humans
Infant
Male
Queensland
Risk Assessment
Risk Factors
Tomography, X-Ray Computed
viral infection
bacterial infection
bronchiectasis
pediatric lung disease
respiratory infection
ISSN:1931-3543, 1931-3543
Online Access:Get more information
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Summary: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. 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. 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. 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.
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ISSN:1931-3543
1931-3543
DOI:10.1016/j.chest.2016.06.030