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Peek R, Walker L, Singleton R. Chronic cough in preschool aged children. BMJ 2024; 386:e079747. [PMID: 39222970 DOI: 10.1136/bmj-2024-079747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Russell Peek
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
- Three Counties Medical School, University of Worcester
| | - Louise Walker
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
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Auld SC, Sheshadri A, Alexander-Brett J, Aschner Y, Barczak AK, Basil MC, Cohen KA, Dela Cruz C, McGroder C, Restrepo MI, Ridge KM, Schnapp LM, Traber K, Wunderink RG, Zhang D, Ziady A, Attia EF, Carter J, Chalmers JD, Crothers K, Feldman C, Jones BE, Kaminski N, Keane J, Lewinsohn D, Metersky M, Mizgerd JP, Morris A, Ramirez J, Samarasinghe AE, Staitieh BS, Stek C, Sun J, Evans SE. Postinfectious Pulmonary Complications: Establishing Research Priorities to Advance the Field: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 21:1219-1237. [PMID: 39051991 DOI: 10.1513/annalsats.202406-651st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Continued improvements in the treatment of pulmonary infections have paradoxically resulted in a growing challenge of individuals with postinfectious pulmonary complications (PIPCs). PIPCs have been long recognized after tuberculosis, but recent experiences such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have underscored the importance of PIPCs following other lower respiratory tract infections. Independent of the causative pathogen, most available studies of pulmonary infections focus on short-term outcomes rather than long-term morbidity among survivors. In this document, we establish a conceptual scope for PIPCs with discussion of globally significant pulmonary pathogens and an examination of how these pathogens can damage different components of the lung, resulting in a spectrum of PIPCs. We also review potential mechanisms for the transition from acute infection to PIPC, including the interplay between pathogen-mediated injury and aberrant host responses, which together result in PIPCs. Finally, we identify cross-cutting research priorities for the field to facilitate future studies to establish the incidence of PIPCs, define common mechanisms, identify therapeutic strategies, and ultimately reduce the burden of morbidity in survivors of pulmonary infections.
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Danino L, Stehling F, Eckerland M, Orhan E, Tschiedel E. Neutrophilia in the bronchoalveolar lavage fluid increases coughing during flexible fiberoptic bronchoscopy in a pediatric cohort. Front Pediatr 2024; 12:1347983. [PMID: 39040668 PMCID: PMC11260698 DOI: 10.3389/fped.2024.1347983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/12/2024] [Indexed: 07/24/2024] Open
Abstract
Objective This study is an addition to the already published prospective randomized double-blinded trial by Tschiedel et al. that compared two different sedation regimes in fiberoptic flexible bronchoscopy in pediatric subjects. The objective of the presented study is to analyze the correlation between the neutrophil percentage of the bronchoalveolar lavage fluid (BALF) and coughing episodes during bronchoscopy. Methods Fifty subjects, aged 1-17 years, received flexible fiberoptic bronchoscopy under deep sedation. The BALF of 39 subjects was analyzed with reference to cytology and microbiology. Results The percentage of neutrophils from the total cell count ranged from 0% to 95.3% (median 2.7). Nineteen patients (49%) had a percentage of ≥3.0%. Pearson's correlation showed a high correlation (r = 0.529, p = 0.001) between the coughing episodes per minute and the neutrophil percentage in the BALF. Analysis of variance showed a significant difference in neutrophil percentage between the indication groups (p = 0.013). The t-test (p = 0.019) showed a significant difference between the neutrophil percentage for patients with a probable airway infection under immunosuppression (median 2.9) and patients with cystic fibrosis (median 49.6). The linear regression analysis showed a significantly stronger impact of the neutrophil percentage on coughing frequency than the sedation regime (βneutrophils = 0.526 with p = 0.001 vs. βsedation = 0.165 with p = 0.251). Conclusion When bronchoscopy is to be performed on a pediatric patient with suspected bacterial or viral infection, and therefore neutrophilic airway inflammation, coughing is to be expected.
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Affiliation(s)
- Laura Danino
- Department of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Eckerland
- Department of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Eser Orhan
- Department of Pediatric Research Network, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Eva Tschiedel
- Department of Pediatric Intensive Care, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
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Kappler U, Henningham A, Nasreen M, Yamamoto A, Buultjens AH, Stinear TP, Sly P, Fantino E. Tolerance to Haemophilus influenzae infection in human epithelial cells: Insights from a primary cell-based model. PLoS Pathog 2024; 20:e1012282. [PMID: 38990812 PMCID: PMC11239077 DOI: 10.1371/journal.ppat.1012282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
Haemophilus influenzae is a human respiratory pathogen and inhabits the human respiratory tract as its only niche. Despite this, the molecular mechanisms that allow H. influenzae to establish persistent infections of human epithelia are not well understood. Here, we have investigated how H. influenzae adapts to the host environment and triggers the host immune response using a human primary cell-based infection model that closely resembles human nasal epithelia (NHNE). Physiological assays combined with dualRNAseq revealed that NHNE from five healthy donors all responded to H. influenzae infection with an initial, 'unproductive' inflammatory response that included a strong hypoxia signature but did not produce pro-inflammatory cytokines. Subsequently, an apparent tolerance to large extracellular and intraepithelial burdens of H. influenzae developed, with NHNE transcriptional profiles resembling the pre-infection state. This occurred in parallel with the development of intraepithelial bacterial populations, and appears to involve interruption of NFκB signalling. This is the first time that large-scale, persistence-promoting immunomodulatory effects of H. influenzae during infection have been observed, and we were able to demonstrate that only infections with live, but not heat-killed H. influenzae led to immunomodulation and reduced expression of NFκB-controlled cytokines such as IL-1β, IL-36γ and TNFα. Interestingly, NHNE were able to re-activate pro-inflammatory responses towards the end of the 14-day infection, resulting in release of IL-8 and TNFα. In addition to providing first molecular insights into mechanisms enabling persistence of H. influenzae in the host, our data further indicate the presence of infection stage-specific gene expression modules, highlighting fundamental similarities between immune responses in NHNE and canonical immune cells, which merit further investigation.
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Affiliation(s)
- Ulrike Kappler
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Australia
| | - Anna Henningham
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Marufa Nasreen
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Australia
| | - Ayaho Yamamoto
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Andrew H. Buultjens
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Peter Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Emmanuelle Fantino
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
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5
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Wiltingh H, Marchant JM, Goyal V. Cough in Protracted Bacterial Bronchitis and Bronchiectasis. J Clin Med 2024; 13:3305. [PMID: 38893016 PMCID: PMC11172502 DOI: 10.3390/jcm13113305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Chronic cough in children is a common condition for which patients seek medical attention, and there are many etiologies. Of the various causes of chronic cough in children, protracted bacterial bronchitis (PBB) is one of the commonest causes, and bronchiectasis is one of the most serious. Together, they lie on different ends of the spectrum of chronic wet cough in children. Cough is often the only symptom present in children with PBB and bronchiectasis. This review highlights the role of cough as a marker for the presence of these conditions, as well as an outcome endpoint for treatment and research.
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Affiliation(s)
- Hinse Wiltingh
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (H.W.); (J.M.M.)
| | - Julie Maree Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (H.W.); (J.M.M.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Vikas Goyal
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (H.W.); (J.M.M.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Department of Pediatrics, Gold Coast Health, Gold Coast, QLD 4215, Australia
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6
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Chang AB, Dharmage SC, Marchant JM, McCallum GB, Morris PS, Schultz A, Toombs M, Wurzel DF, Yerkovich ST, Grimwood K. Improving the Diagnosis and Treatment of Paediatric Bronchiectasis Through Research and Translation. Arch Bronconeumol 2024; 60:364-373. [PMID: 38548577 DOI: 10.1016/j.arbres.2024.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 06/05/2024]
Abstract
Bronchiectasis, particularly in children, is an increasingly recognised yet neglected chronic lung disorder affecting individuals in both low-to-middle and high-income countries. It has a high disease burden and there is substantial inequity within and between settings. Furthermore, compared with other chronic lung diseases, considerably fewer resources are available for children with bronchiectasis. The need to prevent bronchiectasis and to reduce its burden also synchronously aligns with its high prevalence and economic costs to health services and society. Like many chronic lung diseases, bronchiectasis often originates early in childhood, highlighting the importance of reducing the disease burden in children. Concerted efforts are therefore needed to improve disease detection, clinical management and equity of care. Modifiable factors in the causal pathways of bronchiectasis, such as preventing severe and recurrent lower respiratory infections should be addressed, whilst also acknowledging the role played by social determinants of health. Here, we highlight the importance of early recognition/detection and optimal management of bronchiectasis in children, and outline our research, which is attempting to address important clinical knowledge gaps discussed in a recent workshop. The research is grouped under three themes focussing upon primary prevention, improving diagnosis and disease characterisation, and providing better management. Our hope is that others in multiple settings will undertake additional studies in this neglected field to further improve the lives of people with bronchiectasis. We also provide a resource list with links to help inform consumers and healthcare professionals about bronchiectasis and its recognition and management.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gabrielle B McCallum
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter S Morris
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute and Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Maree Toombs
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle F Wurzel
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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O’Farrell HE, Kok HC, Goel S, Chang AB, Yerkovich ST. Endotypes of Paediatric Cough-Do They Exist and Finding New Techniques to Improve Clinical Outcomes. J Clin Med 2024; 13:756. [PMID: 38337450 PMCID: PMC10856076 DOI: 10.3390/jcm13030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic cough is a common symptom of many childhood lung conditions. Given the phenotypic heterogeneity of chronic cough, better characterization through endotyping is required to provide diagnostic certainty, precision therapies and to identify pathobiological mechanisms. This review summarizes recent endotype discoveries in airway diseases, particularly in relation to children, and describes the multi-omic approaches that are required to define endotypes. Potential biospecimens that may contribute to endotype and biomarker discoveries are also discussed. Identifying endotypes of chronic cough can likely provide personalized medicine and contribute to improved clinical outcomes for children.
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Affiliation(s)
- Hannah E. O’Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Hing Cheong Kok
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Department of Paediatrics, Sabah Women and Children’s Hospital, Kota Kinabalu 88996, Sabah, Malaysia
| | - Suhani Goel
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Anne B. Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
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Liptzin DR, Neemann K, McCulloh R, Singleton R, Smith P, Carlson JC. Controversies in Antibiotic Use for Chronic Wet Cough in Children. J Pediatr 2024; 264:113762. [PMID: 37778412 PMCID: PMC11216076 DOI: 10.1016/j.jpeds.2023.113762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Deborah R Liptzin
- University of Montana School of Public and Community Health Sciences, Missoula, MT; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Kari Neemann
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | | | - Paul Smith
- University of Montana School of Public and Community Health Sciences, Missoula, MT
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Singhal KK, Singh R. Chronic Suppurative Lung Disease in Children: A Case Based Approach. Indian J Pediatr 2023; 90:920-926. [PMID: 37389774 DOI: 10.1007/s12098-023-04665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
Bronchiectasis is a pathologic state of conducting airways manifested radiographically by evidence of bronchial dilation and clinically by chronic productive cough. Considered an "orphan disease" for long, it remains a major contributor to morbidity and mortality in both developed and underdeveloped countries. With the advances in the medical field accompanied by widespread access to vaccines and antibiotics, improved health services and better access to nutrition, the incidences of bronchiectasis have markedly decreased, particularly in developed countries. This review summarizes the current knowledge pertaining to the clinical definition, etiology, clinical approach and management related to pediatric bronchiectasis.
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Affiliation(s)
- Kamal Kumar Singhal
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India.
| | - Robin Singh
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India
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Zhang R, Wang L, Gong C, Gao H, Li W, Bian C, Zhao J, Ding S, Zhu Y. Associated Risk Factors and Diagnostic Value of Fiberoptic Bronchoscopy for Protracted Bacterial Bronchitis in Children. Int J Clin Pract 2023; 2023:8116651. [PMID: 37449299 PMCID: PMC10338127 DOI: 10.1155/2023/8116651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Untreated protracted bacterial bronchitis (PBB), a chronic wet cough prevalent in children, may lead to chronic suppurative lung disease. However, clinical diagnostic criteria are currently nonspecific; thus, PBB may be misdiagnosed. Thus, we assessed the diagnostic value of fiberoptic bronchoscopy (FOB) and the risk factors associated with PBB. Methods Children with chronic cough at The First Affiliated Hospital of Anhui Medical University from January 2015 to May 2020 were enrolled and allocated to a suspected PBB (n = 141) or a non-PBB (n = 206) group. All children underwent extensive laboratory, chest imaging, and allergen tests. Children with suspected PBB underwent FOB with bronchoalveolar lavage; lavage and sputum samples were cultured. Results All 347 children had a chronic wet cough for approximately 2 months. Of 141 children with suspected PBB, 140 received FOB with bronchoalveolar lavage. Visible tracheal changes included pale mucosa, mucosal congestion, edema, swelling, and increased secretions attached to the wall. Sputum was visible primarily in the left main bronchus (78.7%), left lower lobe (59.6%), right upper lobe (62.4%), and right lower lobe (64.5%). Sputum properties and amounts significantly differed between children with vs. without PBB (P < 0.05). Dermatophagoides (odds ratio (OR), 2.642; 95% CI, 1.283-5.369), milk protein (OR, 2.452; 95% CI, 1.243-4.836) allergies, and eczema (OR, 1.763; 95% CI, 1.011-3.075) were risk factors significantly associated with PBB. Conclusion Dermatophagoides, milk protein, and eczema were associated with an increased risk of PBB. Sputum distribution and tracheal wall changes observed through FOB may distinguish PBB and assist in its diagnosis.
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Affiliation(s)
- Rong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Li Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Chen Gong
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Wenhong Li
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Chenrong Bian
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Jiaying Zhao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Shenggang Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Yulin Zhu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
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Chatziparasidis G, Kantar A, Grimwood K. Pathogenesis of nontypeable Haemophilus influenzae infections in chronic suppurative lung disease. Pediatr Pulmonol 2023. [PMID: 37133207 DOI: 10.1002/ppul.26446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/09/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
The respiratory tract antimicrobial defense system is a multilayered defense mechanism that relies upon mucociliary clearance and components of both the innate and adaptive immune systems to protect the lungs from inhaled or aspirated microorganisms. One of these potential pathogens, nontypeable Haemophilus influenzae (NTHi), adopts several, multifaceted redundant strategies to successfully colonize the lower airways and establish a persistent infection. NTHi can impair mucociliary clearance, express multiple multifunctional adhesins for various cell types within the respiratory tract and evade host defenses by surviving within and between cells, forming biofilms, increasing antigenic drift, secreting proteases and antioxidants, and by host-pathogen cross-talk, impair macrophage and neutrophil function. NTHi is recognized as an important pathogen in several chronic lower respiratory disorders, such as protracted bacterial bronchitis, bronchiectasis, cystic fibrosis, and primary ciliary dyskinesia. The persistence of NTHi in human airways, including its capacity to form biofilms, results in chronic infection and inflammation, which can ultimately injure airway wall structures. The complex nature of the molecular pathogenetic mechanisms employed by NTHi is incompletely understood but improved understanding of its pathobiology will be important for developing effective therapies and vaccines, especially given the marked genetic heterogeneity of NTHi and its possession of phase-variable genes. Currently, no vaccine candidates are ready for large phase III clinical trials.
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Affiliation(s)
- Grigorios Chatziparasidis
- Paediatric Respiratory Unit, IASO Hospital, Larissa, Thessaly, Greece
- Faculty of Nursing, Thessaly University, Larissa, Greece
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Instituti Ospedalieri Bergamaschi, Bergamo, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Keith Grimwood
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
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Ahmed SK, Mohamed MG, Dabou EA, Abuijlan I, Chandran D, El-Shall NA, Chopra H, Dhama K. Monkeypox (mpox) in immunosuppressed patients. F1000Res 2023; 12:127. [PMID: 37089133 PMCID: PMC10113800 DOI: 10.12688/f1000research.130272.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
The World Health Organization (WHO) proclaimed a public health emergency in July 2022 due to the emergence of Mpox (formerly monkeypox) while the globe was still dealing with the COVID-19 epidemic. The characteristics of mpox in immunocompetent individuals are well-characterized, despite difficulties in diagnostics, immunization, and access to treatment that persist in low-income countries. Patients with weakened immune systems are more likely to spread an illness and die from it than healthy people because they cannot mount a protective immune response against it, such as a neutralizing IgG and poxvirus-specific Th1 response. A health warning on severe mpox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advice does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as “having autoimmune disease with immunodeficiency as a clinical component”. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, “of the people with severe mpox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression”. However, new cases are still expected to be discovered, especially in low-income countries with limited access to diagnosis, treatment, and prevention, and where a large percentage of the mpox-infected population also has advanced HIV infection. Thus, further research is always needed to determine the best way to treat mpox in immunocompromised people. In this context, we discussed /reviewed the mpox clinical presentation, available treatment options and current preventive guidelines in immunocompromised patients.
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Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Pediatrics, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq
| | - Mona Gamal Mohamed
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Eman Abdelaziz Dabou
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Israa Abuijlan
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, Tamil Nadu, 642109, India
| | - Nahed A. El-Shall
- Department of Poultry and Fish Diseases, Faculty of Veterinary Medicine, Alexandria University, Edfina, El-Beheira, 22758, Egypt
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, 243122, India
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Proesmans M, Vermeulen F, Boon M. Understanding and managing respiratory infections in children and young adults with neurological impairment. Expert Rev Respir Med 2023; 17:203-211. [PMID: 36932917 DOI: 10.1080/17476348.2023.2192483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Patients with neurocognitive impairment (NI) have multiple medical needs, with respiratory problems leading to an important reduction in quality of life and life expectancy. We aimed to explain that the origin of chronic respiratory symptoms in patients with NI is multifactorial. AREAS COVERED In people with NI there is a high prevalence of swallowing dysfunction and hypersalivation inducing aspiration; cough efficacy is decreased resulting in chronic lung infection; sleep-disordered breathing is frequent and muscle mass is abnormal due to malnutrition. Technical investigations are not always specific and sensitive enough to better diagnose the causes of the respiratory symptoms; moreover, they can sometimes be difficult to perform in this vulnerable patient population. We provide a clinical pathway to adopt to identify, prevent, and treat respiratory complications in children and young adults with NI. A holistic approach in discussion with all care providers and the parents is highly recommended. EXPERT OPINION The care for people with NI and chronic respiratory problems is challenging. The interplay between several causative factors may be difficult to entangle. Well-performed clinical research in this field is largely missing and should be encouraged. Only then, evidence-based clinical care will become possible for this vulnerable patient group.
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Affiliation(s)
- Marijke Proesmans
- KU Leuven, Department of Development and Regeneration, Woman and Child Unit, CF Research Lab, Leuven, Belgium
- Department of Pediatrics, Pediatric Pulmonology, University Hospital Leuven, Leuven, Belgium
| | - Francois Vermeulen
- KU Leuven, Department of Development and Regeneration, Woman and Child Unit, CF Research Lab, Leuven, Belgium
- Department of Pediatrics, Pediatric Pulmonology, University Hospital Leuven, Leuven, Belgium
| | - Mieke Boon
- KU Leuven, Department of Development and Regeneration, Woman and Child Unit, CF Research Lab, Leuven, Belgium
- Department of Pediatrics, Pediatric Pulmonology, University Hospital Leuven, Leuven, Belgium
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14
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Ahmed SK, Mohamed MG, Dabou EA, Abuijlan I, Chandran D, El-Shall NA, Chopra H, Dhama K. Monkeypox (mpox) in immunosuppressed patients. F1000Res 2023; 12:127. [PMID: 37089133 PMCID: PMC10113800 DOI: 10.12688/f1000research.130272.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
The World Health Assembly declared that smallpox had been completely eradicated from the human population in 1980. Monkeypox, a zoonosis native to damp forested regions in West and Central Africa, is the illness that is most comparable to smallpox clinically and immunologically. Both illnesses could be prevented by the smallpox vaccine. Although the monkeypox virus is a less effective human disease than the smallpox virus, it could now spread among human populations if smallpox had not been eradicated and population-wide immunity had not been developed. A health warning on severe monkeypox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advise does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as “having autoimmune disease with immunodeficiency as a clinical component”. The documented severe signs of monkeypox include widespread rashes with secondary fungal or bacterial skin infections or tissue death (necrosis), intestine obstruction, and difficulties with the heart, lungs, urinary system, and nervous system. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, “of the people with severe monkeypox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression”. The current article goes into great detail about monkeypox disease occurring in immunocompromised patients and preventive guidelines.
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Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Pediatrics, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq
| | - Mona Gamal Mohamed
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Eman Abdelaziz Dabou
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Israa Abuijlan
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, Tamil Nadu, 642109, India
| | - Nahed A. El-Shall
- Department of Poultry and Fish Diseases, Faculty of Veterinary Medicine, Alexandria University, Edfina, El-Beheira, 22758, Egypt
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, 243122, India
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15
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Chang AB, Oppenheimer JJ, Dunlap W, Lieberman JA, Irwin RS. Yardstick for managing cough. Part 2: in children. Ann Allergy Asthma Immunol 2023; 130:681-689. [PMID: 36736723 DOI: 10.1016/j.anai.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to respiratory specialists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the evidence-based guidelines most of which have been developed from high-quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. Chronic cough in children is often benign and self-limiting. Using established and validated protocols and specific pointers (clues in history, findings on examination) can aid the clinician in identifying causes when present and improve outcomes. In this manuscript, part 2 of the 2-part series, we provide evidence-based, expert opinion recommendations on the management of chronic cough in the pediatric patient (<14 years of age).
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology, and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia; Menzies School of Health Research, Darwin, Australia.
| | | | - Whitney Dunlap
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts; Northeast Allergy, Asthma, and Immunology, Worcester, Massachusetts
| | - Jay Adam Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
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16
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Chen N, Zhang H, Feng Y. Clinical features and pathogen distributions of microbiological-based protracted bacterial bronchitis in children of different ages in Northeast China. Front Pediatr 2023; 11:1163014. [PMID: 37152313 PMCID: PMC10162439 DOI: 10.3389/fped.2023.1163014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Background Protracted bacterial bronchitis (PBB) is often diagnosed clinically according to chronic wet cough, which can be resolved by appropriate antibiotics. Though rarely performed in PBB diagnosis, bacterial cultures by sputum or bronchoalveolar lavage (BAL) fluid can provide etiological features, which may be different in western countries and different areas of China. This study aimed to investigate the clinical and etiological features and outcomes in children of different ages with PBB in northeast China. Methods We retrospectively analyzed children diagnosed with PBB by positive BAL fluid or sputum bacterial cultures between 2017 and 2021. Children were divided into three age groups: <1 year (infants), 1-5 years (younger children), and ≥6 years (older children). Clinical characteristics, chest radiographic findings, bronchoscopy findings, microbiological findings, treatment strategies, and outcomes were reviewed and compared among the age groups. Factors associated with remission during follow-up were examined using logistic regression. Results A total of 45 children with PBB were included, consisting of 24 (53.3%) infants. The infants were often boys and had a shorter cough duration, a lower proportion of expectoration, a greater proportion of wheezing, and less bronchial wall thickening on high-resolution computed tomography compared to older children (P < 0.05). No significant differences were found among the age groups regarding macroscopic findings, except for a higher proportion of tracheobronchial malacia in infants than in older children (P = 0.013). The most commonly cultured bacteria were Haemophilus influenzae (42.2%), followed by Streptococcus pneumoniae (22.2%) and Klebsiella pneumoniae (20.0%). Compared to older children, infants had a higher remission (P = 0.009) and relatively lower relapse rates (P = 0.059). Short duration of cough (OR = 0.58, 95% CI: 0.34-0.99, P = 0.046) and absence of recurrent cephalosporins before diagnosis (OR = 0.05, 95% CI: 0.00-0.73, P = 0.028) were associated with remission. Conclusions Infants are more prone to PBB, with increased wheezing. Gram-negative bacilli infections are common in infants in northeast China. Older children with PBB should be carefully assessed, treated and followed up, particularly those with long duration of cough and poor response to antibiotic treatments.
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17
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Huang L, Lai K, Zhan C, Long L, Yi F, Zhou J, Zhan W, Lu H, Jiang Z, Chen Y, Jiang M, Chen R, Xie J, Luo W. Clinical characteristics of protracted bacterial bronchitis in adults. Heliyon 2022; 9:e12299. [PMID: 36755583 PMCID: PMC9900482 DOI: 10.1016/j.heliyon.2022.e12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/23/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
There are few data regarding adult protracted bacterial bronchitis (PBB). This study aimed to delineate the clinical features of PBB and evaluate their potential diagnostic value in adults. We recruited 55 adult patients with PBB and selected randomly 220 patients with non-PBB as control. A diagnosis of PBB was considered if patients had a cough lasting ≥3 weeks, no abnormalities of chest computed tomography, positive bacterial culture in sputum and/or response well to oral moxifloxacin for 1-4 weeks. The clinical manifestations and laboratory investigations were compared between PBB patients and non-PBB patients. Of the 55 patients with PBB, approximately three-fifths (34, 61.8%) were females with a median age of 46.0 years, which were similar to that of patients with non-PBB. We observed a shorter cough duration in PBB than non-PBB (median 3.0 versus 24.0 months, p < 0.001). Compared to non-PBB patients, PBB patients had higher incidences of productive cough, yellow phlegm and a sensation of mucus in the throat (SMIT) (all p < 0.001). Sputum neutrophils and lymphocytes were markedly elevated in PBB patients than non-PBB patients (both p = 0.004). Bacterial pathogens were detected in eight (28.6%) of 28 cases with PBB. The multivariate analyses showed yellow phlegm, productive cough, SMIT, increased sputum lymphocytes (≥2.3%) and cough duration ≤8.5 months with moderate sensitivity (50.9-81.8%) and moderate-high specificity (60.5-94.4%) for determining PBB. In summary, adults with PBB are characterized by productive cough, yellow phlegm, SMIT and neutrophilic airway inflammation. These cough features and increased sputum lymphocytes may be useful to indicate PBB.
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18
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Laird P, Ball N, Brahim S, Brown H, Chang AB, Cooper M, Cox D, Cox D, Crute S, Foong RE, Isaacs J, Jacky J, Lau G, McKinnon E, Scanlon A, Smith EF, Thomason S, Walker R, Schultz A, Walker R, Schultz A. Prevalence of chronic respiratory diseases in Aboriginal children: A whole population study. Pediatr Pulmonol 2022; 57:3136-3144. [PMID: 36098280 PMCID: PMC9825907 DOI: 10.1002/ppul.26148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The burden of bronchiectasis is disproportionately high in Aboriginal adults, with early mortality. Bronchiectasis precursors, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), often commence in early childhood. We previously reported a 10% prevalence of PBB in Aboriginal children aged 0 to 7 years, however there are no data on prevalence of chronic lung diseases in older children. Our study aimed to determine the prevalence of PBB, CSLD, bronchiectasis, and asthma in Aboriginal children living in four communities. METHODS A whole-population cross-sectional community co-designed study of Aboriginal children aged <18-years in four remote communities in Western Australia across two-time points, a month apart. Children were assessed by pediatric respiratory clinicians with spirometry undertaken (when possible) between March-September 2021. Children with respiratory symptoms were followed up via medical record audit from either the local medical clinic or via a respiratory specialist clinic through to March 2022 to establish a final diagnosis. FINDINGS We recruited 392 (91.6%) of those in the selected communities; median age = 8.4 years (interquartile range [IQR] 5.1-11.5). Seventy children (17.9%) had a chronic respiratory pathology or abnormal spirometry results. PBB was confirmed in 30 (7.7%), CSLD = 13 (3.3%), bronchiectasis = 5 (1.3%) and asthma = 17 (4.3%). The prevalence of chronic wet cough significantly increased with increasing age. INTERPRETATION The prevalence of PBB, CSLD and bronchiectasis is high in Aboriginal children and chronic wet cough increases with age. This study highlights the high disease burden in Aboriginal children and the urgent need for strategies to address these conditions.
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Affiliation(s)
- Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicola Ball
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shekira Brahim
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Henry Brown
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,The Centre of Children's Health Research, Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, Queensland, Australia
| | - Matthew Cooper
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Deanne Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Denetta Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Samantha Crute
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel E Foong
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Janella Isaacs
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - John Jacky
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gloria Lau
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Annie Scanlon
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Elizabeth F Smith
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Sarah Thomason
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, Western Australia, Australia.,School of Population Health, University of Western Australia, Perth, Western Australia, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia.,School of Population Health, University of Western Australia, Perth, WA, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.,Department of Paediatrics, School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, 15 Hospital Ave, Nedlands, 6009, WA, Australia
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19
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Masson V, Kier C, Chandran L. Cough Conundrums: A Guide to Chronic Cough in the Pediatric Patient. Pediatr Rev 2022; 43:691-703. [PMID: 36450640 DOI: 10.1542/pir.2021-005398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Vicki Masson
- Division of Pediatric Pulmonology and Sleep Medicine
| | - Catherine Kier
- Division of Pediatric Pulmonology, Stony Brook University, Stony Brook, NY
| | - Latha Chandran
- Department of Medical Education and Pediatrics, University of Miami, Miller School of Medicine, Miami, FL
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20
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Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with Pseudomonas aeruginosa. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121822. [PMID: 36553266 PMCID: PMC9776566 DOI: 10.3390/children9121822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with Pa. Data of 54 children with CSLD/bronchiectasis who were diagnosed and attended in our department were retrospectively analysed through a Cox proportional hazard model, with age, presence of bronchiectasis, use of inhaled colistin, azithromycin, inhaled hypertonic saline as the covariates. In 42 of the 54 patients, there was no identifiable cause or underlying chronic disorder. Microbiological clearance was defined as the absence of daily wet cough for four months along with four negative cultures taken during the last four consecutive follow-up visits. Multivariate analysis was performed with a Cox proportional hazard model with time to microbiological clearance as the outcome. Results are described as Hazard Ratios (HR) with 95% Confidence Intervals (95%CI). Nebulised antibiotics and the presence of bronchiectasis were statistically significant predictors of remission (HR: 3.99; 95%CI: 1.12-14.14; p = 0.032, and HR: 0.24; 95%CI: 0.08-0.71; p = 0.010). In conclusion, the rate of microbiological clearance increases with the use of inhaled colistin and decreases when there is established bronchiectasis.
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21
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Gilchrist FJ, Aspey M, Bowler R, Brodlie M, Desai S, Harris C, Hinton E, Kulkarni H, Ogbolosingha A, Sinha I, Solis-Trapala I, Stock J, Carroll WD. Protocol for CLASSIC PBB: comparison of lower airway sampling strategies in children with protracted bacterial bronchitis. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001722. [PMID: 36645788 PMCID: PMC9680323 DOI: 10.1136/bmjpo-2022-001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Protracted bacterial bronchitis (PBB) is an endobronchial infection and a the most common cause of chronic wet cough in young children. It is treated with antibiotics, which can only be targeted if the causative organism is known. As most affected children do not expectorate sputum, lower airway samples can only be obtained by bronchoalveolar lavage (BAL) samples taken during flexible bronchoscopy (FB-BAL). This is invasive and is therefore reserved for children with severe or relapsing cases. Most children with PBB are treated empirically with broad spectrum antibiotics. CLASSIC PBB will compare the pathogen yield from two less invasive strategies with that from FB-BAL to see if they are comparable. METHODS 131 children with PBB from four UK centres referred FB-BAL will be recruited. When attending for FB-BAL, they will have a cough swab and an induced sputum sample obtained. The primary outcome will be the discordance of the pathogen yield from the cough swab and the induced sputum when compared with FB-BAL. Secondary outcomes will be the sensitivity of each sampling strategy, the success rate of the induced sputum in producing a usable sample and the tolerability of each of the three sampling strategies. DISCUSSION If either or both of the two less invasive airway sampling strategies are shown to be a useful alternative to FB-BAL, this will lead to more children with PBB having lower airway samples enabling targeted antibiotic prescribing. It would also reduce the need for FB, which is known to be burdensome for children and their families. TRIAL REGISTRATION NUMBER ISRCTN79883982.
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Affiliation(s)
- Francis J Gilchrist
- Institute of Applied Clinical Science, Keele University, Keele, UK .,Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Mathew Aspey
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Robert Bowler
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Malcolm Brodlie
- Institute of Celular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Seema Desai
- Department of Microbiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Caroline Harris
- Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Emily Hinton
- On Behalf of Patient and Public Involvement and Engagement for CLASSIC PBB, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Hemant Kulkarni
- Sheffield Children's Hosptial, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aviva Ogbolosingha
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ian Sinha
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Joanne Stock
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - William D Carroll
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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22
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Tseng FH, Newman M, Song CH. Chronic and Recurrent Sinusitis in Children, as Manifestation of Immune Dysfunction and Atopic Background. Adv Pediatr 2022; 69:75-93. [PMID: 35985718 DOI: 10.1016/j.yapd.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rhinosinusitis in children, as in adults, can be classified by duration (acute, recurrent, and chronic) and by cause (viral, bacterial, and inflammatory) and needs to be treated accordingly after careful investigation which include through clinical history, laboratory tests, and, if necessary, nasal endoscopy and imaging studies.
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Affiliation(s)
- Farn-Hsuan Tseng
- Harbor-University of California, Los Angeles, Torrance, CA 90509, USA
| | - Marissa Newman
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Charles H Song
- Harbor-University of California, Los Angeles, Torrance, CA 90509, USA.
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23
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McElrea E, Chang AB, Yerkovich S, O'Farrell HE, Marchant JM. Mucolytics for children with chronic suppurative lung disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Esther McElrea
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
| | - Anne B Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Department of Respiratory and Sleep Medicine; Queensland Children's Hospital; Brisbane Australia
- Menzies School of Health Research; Charles Darwin University; Darwin Australia
| | - Stephanie Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Menzies School of Health Research; Charles Darwin University; Darwin Australia
| | - Hannah E O'Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology; Brisbane Australia
- Menzies School of Health Research, Charles Darwin University; Darwin Australia
| | - Julie M Marchant
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Brisbane Australia
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24
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Extended Versus Standard Antibiotic Course Duration in Children <5 Years of Age Hospitalized With Community-acquired Pneumonia in High-risk Settings: Four-week Outcomes of a Multicenter, Double-blind, Parallel, Superiority Randomized Controlled Trial. Pediatr Infect Dis J 2022; 41:549-555. [PMID: 35476706 DOI: 10.1097/inf.0000000000003558] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND High-level evidence is limited for antibiotic duration in children hospitalized with community-acquired pneumonia (CAP) from First Nations and other at-risk populations of chronic respiratory disorders. As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP. METHODS In our multinational (Australia, New Zealand, Malaysia), double-blind, superiority randomized controlled trial, children hospitalized with uncomplicated, radiographic-confirmed, CAP received 1-3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and then randomized to extended (13-14 days duration) or standard (5-6 days) antibiotics. The primary outcome was clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrollment. Secondary outcomes included adverse events, nasopharyngeal bacterial pathogens and antimicrobial resistance at 4 weeks. RESULTS Of 372 children enrolled, 324 fulfilled the inclusion criteria and were randomized. Using intention-to-treat analysis, between-group clinical cure rates were similar (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81.3%; relative risk = 0.96, 95% confidence interval = 0.86-1.07). There were no significant between-group differences for adverse events (extended course: n = 43/163, 26.4%; standard course, n = 32/161, 19.9%) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance. CONCLUSIONS Among children hospitalized with pneumonia and at-risk of chronic respiratory illnesses, an extended antibiotic course was not superior to a standard course at achieving clinical cure at 4 weeks. Additional research will identify if an extended course provides longer-term benefits.
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Büyükşahin HN, Emiralioğlu N, Tural DA, Özsezen B, Sunman B, Güzelkaş İ, Yalçın E, Doğru D, Özçelik U, Kiper N. The Importance of Flexible Bronchoscopy in Difficult-to-treat Asthma from a Pediatric Pulmonology Perspective. Turk Arch Pediatr 2022; 57:310-315. [PMID: 35781234 PMCID: PMC9131811 DOI: 10.5152/turkarchpediatr.2022.21315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Asthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4 or 5 of Global Initiative for Asthma therapy. In the differential diagnosis of these patients, flexible fiberoptic bronchoscopy is recommended to exclude other lung diseases. In this study, we aimed to examine the clinical and radiologic features and flexible fiberoptic bronchoscopy findings of patients referred to our pediatric pulmonology department due to difficult-to-treat asthma and determine the effects of flexible fiberoptic bronchoscopy on the differential diagnosis and treatment. MATERIALS AND METHODS The demographic characteristics and flexible fiberoptic bronchoscopy results of 62 patients who were diagnosed as having difficult-to-treat asthma in our pediatric pulmonology department between January 2015 and June 2020 were evaluated retrospectively. The symptoms, history, medications, physical examination findings, pulmonary function tests, and radiologic findings of patients who underwent flexible fiberoptic bronchoscopy were evaluated. RESULTS The median age of the patients was 69 (interquartile range: 42-108 months). The most common reasons for the referral of these patients were chronic cough, recurrent pulmonary infections, and persistent wheezing. All patients had chest radiography and 37 (59.7%) had chest computed tomography at their first admission; 14 (37.8%) patients had abnormal findings on chest computed tomography. There was no significant difference in terms of age, physical examination findings, pulmonary function test results, and radiologic examinations between patients with and without pathologic bronchoscopy findings. None of the patients had complications during and after flexible fiberoptic bronchoscopy. The most common diagnoses of patients based on flexible fiberoptic bronchoscopy were persistent bacterial bronchitis in 19 (30.6%) patients, tracheomalacia and/or bronchomalacia in 12 (19.4%), and anatomic anomalies in 3 (4.8%) patients (separation of lingula into 3, separation of right upper lobe bronchus into 4, and tracheal dyskinesia). Mycobacterium tuberculosis growth was observed in the tuberculosis culture of 1 patient. According to the flexible fiberoptic bronchoscopy and bronchoalveolar lavage results, antituberculosis treatment was initiated in 1 patient and polypoid mass excision was performed in 1 patient. A proton pump inhibitor was started in 9 (15.5%) patients, physiotherapy in 5 (8.0%), antibiotics in 14 (22.5%), and ipratropium bromide in 7 (11.2%) patients. All patients were followed up with the diagnosis of asthma except for 2 patients. CONCLUSION To date, there is no prospective study evaluating the importance of flexible fiberoptic bronchoscopy in difficult-to-treat asthma in childhood. In our small cohort, persistent bacterial bronchitis, airway tracheomalacia and/or bronchomalacia, gastroesophageal reflux, and other anatomic anomalies were successfully diagnosed using flexible fiberoptic bronchoscopy and treated without any complications, suggesting that flexible fiberoptic bronchoscopy is an important diagnostic tool with a low complication rate in children with difficult-to-treat asthma.
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Affiliation(s)
- Halime Nayir Büyükşahin
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Beste Özsezen
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - İsmail Güzelkaş
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, İhsan Doğramacı Children’s Hospital, Ankara, Turkey
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Mukerji SS, Yenduri NJS, Chiou E, Moonnumakal SP, Bedwell JR. A multi‐disciplinary approach to chronic cough in children. Laryngoscope Investig Otolaryngol 2022; 7:409-416. [PMID: 35434349 PMCID: PMC9008181 DOI: 10.1002/lio2.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/02/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives (1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough. Methods Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar. Conclusion Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi‐disciplinary approach is cost‐effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft‐type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive. Level of Evidence: 2a
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Affiliation(s)
- Shraddha S. Mukerji
- Department of Otolaryngology Head Neck Surgery Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Naga Jaya Smitha Yenduri
- Department of Pulmonary Medicine and Critical Care Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Eric Chiou
- Department of Gastroenterology and Nutrition Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Siby P. Moonnumakal
- Department of Pulmonary Medicine and Critical Care Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Joshua R. Bedwell
- Department of Otolaryngology Head Neck Surgery Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
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27
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Goyal V, Chang AB. Bronchiectasis in Childhood. Clin Chest Med 2022; 43:71-88. [DOI: 10.1016/j.ccm.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ezmigna D, Brown M, Daines C, Morgan W. Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index. Pediatr Pulmonol 2022; 57:293-299. [PMID: 34609079 DOI: 10.1002/ppul.25716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS). DESIGN Retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API+, 12 API-). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages were analyzed. Cell counts presented as median (range). RESULTS Neutrophil percentages were increased in both groups (API- 16% [1%-76%]; API+ 42% [1%-95%]; p = NS). Cell percentages were similar for lymphocytes (API- 12% [1%-30%]; API+ 7% [1%-37%]), and macrophages (API- 67.5% [12%-97%]; API+ 41% [2%-94%]). Eosinophil percentages were low in both groups (API- 1% [1%-2%]; API+ 1% [1%-11%]). There was no difference in cellular distributions using absolute cell counts comparing API groups. Bacterial cultures were positive in 18 (60%) API+ and 5 (41%) API- patients (p = 0.10). CONCLUSION Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Neutrophil percentages and total granulocyte count correlate with positive bacterial cultures independent of API status. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to ICS therapy regardless of API status with a trend to more positive cultures in API positive children.
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Affiliation(s)
- Dima Ezmigna
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Mark Brown
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori Daines
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
| | - Wayne Morgan
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
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Capizzi A, Salvati P, Gallizia A, Rossi GA, Sacco O. Is secondary tracheomalacia associated with airway inflammation and infection? Pediatr Int 2022; 64:e15034. [PMID: 34674343 DOI: 10.1111/ped.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recurrent lower respiratory tract infections are among the most prevalent symptoms in secondary tracheomalacia due to mediastinal vascular anomalies (MVAs). It is not known whether this condition could result in persistent lower respiratory tract inflammation and subclinical infection. METHODS A retrospective study was performed on records of children with tracheomalacia due to MVAs and recurrent respiratory infections who underwent computed tomography scan, bronchoscopy, and bronchoalveolar lavage (BAL) as part of their clinical evaluation. RESULTS Thirty-one children were included in the study: 21 with aberrant innominate artery, four with right aortic arch, one with double aortic arch, and five with aberrant innominate artery associated with right aortic arch. Cytological evaluation of bronchoalveolar lavage fluid showed increased neutrophil percentages and normal lymphocyte and eosinophil proportions. Microorganism growth was detected in 13 BAL samples, with a bacterial load ≥104 colony-forming units/mL in eight (25.8%) of them. Most isolates were positive for Haemophilus influenzae. Bronchiectasis was detected in four children, all with BAL culture positive for H. influenzae. Four patients underwent MVA surgical correction and 27 conservative management, i.e., respiratory physiotherapy in all and high-dose amoxicillin/clavulanic acid (40 mg/kg/day) for 2-4 weeks in those with significant bacterial growth. There was an excellent outcome in most of them. CONCLUSIONS Neutrophilic alveolitis is detectable in secondary tracheomalacia but is associated with a clinically significant bacterial load only in a quarter of the patients. Caution should be used regarding inappropriate antibiotic prescriptions to avoid the emergence of resistance, whilst airway clearance maneuvers and infection preventive measures should be promoted.
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Affiliation(s)
- Antonino Capizzi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Pietro Salvati
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Annalisa Gallizia
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Giovanni A Rossi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Oliviero Sacco
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
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Nomura N, Matsumoto H, Yokoyama A, Nishimura Y, Asano K, Niimi A, Tohda Y, Harada N, Nagase H, Nagata M, Inoue H, Kondo M, Horiguchi T, Miyahara N, Hizawa N, Hojo M, Hattori N, Hashimoto N, Yamasaki A, Kadowaki T, Kimura T, Miki M, Taniguchi H, Toyoshima M, Kawamura T, Matsuno O, Sato Y, Sunadome H, Nagasaki T, Oguma T, Hirai T. Nationwide survey of refractory asthma with bronchiectasis by inflammatory subtypes. Respir Res 2022; 23:365. [PMID: 36539765 PMCID: PMC9763800 DOI: 10.1186/s12931-022-02289-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Bronchiectasis and bronchiolitis are differential diagnoses of asthma; moreover, they are factors associated with worse asthma control. OBJECTIVE We determined clinical courses of bronchiectasis/bronchiolitis-complicated asthma by inflammatory subtypes as well as factors affecting them. METHODS We conducted a survey of refractory asthma with non-cystic fibrosis bronchiectasis/bronchiolitis in Japan. Cases were classified into three groups, based on the latest fractional exhaled NO (FeNO) level (32 ppb for the threshold) and blood eosinophil counts (320/µL for the threshold): high (type 2-high) or low (type 2-low) FeNO and eosinophil and high FeNO or eosinophil (type 2-intermediate). Clinical courses in groups and factors affecting them were analysed. RESULTS In total, 216 cases from 81 facilities were reported, and 142 were stratified: 34, 40 and 68 into the type 2-high, -intermediate and -low groups, respectively. The frequency of bronchopneumonia and exacerbations requiring antibiotics and gram-negative bacteria detection rates were highest in the type 2-low group. Eighty-seven cases had paired latest and oldest available data of FeNO and eosinophil counts; they were analysed for inflammatory transition patterns. Among former type 2-high and -intermediate groups, 32% had recently transitioned to the -low group, to which relatively low FeNO in the past and oral corticosteroid use contributed. Lastly, in cases treated with moderate to high doses of inhaled corticosteroids, the frequencies of exacerbations requiring antibiotics were found to be higher in cases with more severe airway lesions and lower FeNO. CONCLUSIONS Bronchiectasis/bronchiolitis-complicated refractory asthma is heterogeneous. In patients with sputum symptoms and low FeNO, airway colonisation of pathogenic bacteria and infectious episodes are common; thus, corticosteroids should be carefully used.
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Affiliation(s)
- Natsuko Nomura
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisako Matsumoto
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan ,grid.258622.90000 0004 1936 9967Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka Japan
| | - Akihito Yokoyama
- grid.278276.e0000 0001 0659 9825Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yoshihiro Nishimura
- grid.31432.370000 0001 1092 3077Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichiro Asano
- grid.265061.60000 0001 1516 6626Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Akio Niimi
- grid.260433.00000 0001 0728 1069Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Tohda
- grid.258622.90000 0004 1936 9967Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka Japan
| | - Norihiro Harada
- grid.258269.20000 0004 1762 2738Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Nagase
- grid.264706.10000 0000 9239 9995Department of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Makoto Nagata
- grid.410802.f0000 0001 2216 2631Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hiromasa Inoue
- grid.258333.c0000 0001 1167 1801Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuko Kondo
- grid.410818.40000 0001 0720 6587Department of Respiratory Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takahiko Horiguchi
- Department of Respiratory Medicine, Toyota Regional Medical Center, Toyota, Japan
| | - Nobuaki Miyahara
- grid.261356.50000 0001 1302 4472Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Nobuyuki Hizawa
- grid.20515.330000 0001 2369 4728Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Hojo
- grid.45203.300000 0004 0489 0290Department of Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Noboru Hattori
- grid.257022.00000 0000 8711 3200Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naozumi Hashimoto
- grid.27476.300000 0001 0943 978XDepartment of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Yamasaki
- grid.265107.70000 0001 0663 5064Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Toru Kadowaki
- Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Japan
| | - Tomoki Kimura
- grid.417192.80000 0004 1772 6756Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Mari Miki
- grid.416803.80000 0004 0377 7966Department of Respiratory Medicine, National Hospital Organization Toneyama Medical Center, Osaka, Japan
| | - Hirokazu Taniguchi
- grid.417235.60000 0001 0498 6004Department of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Mikio Toyoshima
- grid.413556.00000 0004 1773 8511Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Tetsuji Kawamura
- grid.414101.10000 0004 0569 3280Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Osamu Matsuno
- Department of Allergy and Rheumatoid disease, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoko Sato
- Department of Respiratory Medicine, Yuuai Medical Center, Okinawa, Japan
| | - Hironobu Sunadome
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan ,grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Nagasaki
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan ,grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsuyoshi Oguma
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toyohiro Hirai
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121161. [PMID: 34943357 PMCID: PMC8700365 DOI: 10.3390/children8121161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Background: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. Methods: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. Results: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae) was significantly higher (p = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65–96%) and 48% (95% CI: 31–66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47–65%) and 80% (95% CI: 60–91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies.
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Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies. J Clin Med 2021; 10:jcm10245735. [PMID: 34945030 PMCID: PMC8707704 DOI: 10.3390/jcm10245735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/26/2023] Open
Abstract
We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.
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Ntesou D, Douros K, Tsiambas E, Maipas S, Sarlanis H, Lazaris AC, Kavantzas N. Impact of Immune-Inflammatory Microenvironment Alterations on the Bronchial Lumen of Children With Protracted Bacterial Bronchitis. Cureus 2021; 13:e20554. [PMID: 35103134 PMCID: PMC8776515 DOI: 10.7759/cureus.20554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Protracted bacterial bronchitis is a syndrome that is among the most common causes of chronic cough. In order to understand its pathogenetic mechanisms, there is an increasing interest in the study of the immune microenvironment in the bronchial lumen. The aim of this retrospective study is the determination of the types and quantity of the inflammatory cells that infiltrate the bronchial epithelium as well as of the thickness of the basement membrane. Ninety-seven endobronchial biopsies, obtained from 77 children (30 males and 47 females) aged between 5 and 14 years, with chronic (>8 weeks) wet/productive cough, were subjected to hematoxylin and eosin staining. Using an appropriate image analysis and processing software, we determined the types and the quantity of the inflammatory cells that infiltrated the bronchial epithelium, and the thickness of the basement membrane. The metric data were then subjected to extensive statistical analysis. According to our results, females had increased levels of eosinophils (p = 0.021) and lymphocytes (p = 0.044) compared to males. Moreover, we found that membrane thickness was negatively correlated with the number of eosinophils (p < 0.0001), neutrophils (p = 0.023), and lymphocytes (p = 0.024). Finally, the pairwise comparisons of the number of eosinophils, neutrophils, lymphocytes, and other cell types revealed significant (p < 0.05) positive correlations. Protracted bacterial bronchitis activates pulmonary innate immune pathways. Also, it is accompanied by basement membrane thickening, which is a typical characteristic of several respiratory diseases, such as asthma.
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Affiliation(s)
- Despoina Ntesou
- Department of Laboratory Medicine, University of West Attica, Egaleo, GRC
| | - Konstantinos Douros
- Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Evangelos Tsiambas
- Department of Cytopathology, 417 Army Equity Fund Hospital (NIMTS), Athens, GRC
| | - Sotirios Maipas
- Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Helen Sarlanis
- Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Andreas C Lazaris
- Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Chang AB, Boyd J, Bush A, Grimwood K, Hill AT, Powell Z, Yerkovich S, Zacharasiewicz A, Kantar A. Children's Bronchiectasis Education Advocacy and Research Network (Child-BEAR-Net): an ERS Clinical Research Collaboration on improving outcomes of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:58/4/2101657. [PMID: 34675034 DOI: 10.1183/13993003.01657-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia
| | | | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Australia
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Angela Zacharasiewicz
- Dept of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
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Ferraro VA, Baraldi E, Stabinger D, Zamunaro A, Zanconato S, Carraro S. Pediatric flexible bronchoscopy: A single-center report. Pediatr Pulmonol 2021; 56:2634-2641. [PMID: 33969642 PMCID: PMC8360175 DOI: 10.1002/ppul.25458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Pediatric flexible laryngotracheal bronchoscopy (FB) is an integral part of diagnostics and treatment at tertiary pediatric respiratory centers. AIM FBs performed between 2013 and 2018 at our Pediatric Allergy and Respiratory Medicine Unit of the Department of Women's and Children's Health at Padua University were examined in terms of the indications, findings, and adverse events. MATERIALS AND METHODS The electronic medical records of pediatric patients who underwent FB at least once between 1 January 2013 and 31 December 2018 were considered. Patients' clinical data, indications for FB, anatomical findings, information derived from bronchoalveolar lavage (BAL) and bronchial brushing, and possible adverse events were analyzed. RESULTS There were 447 pediatric FBs performed in 428 patients (aged from 1 month to 18 years) for diagnostic purposes (92.4%), to clear secretions (3.6%), or to monitor a known condition (4.0%). The main indications were recurrent lower respiratory tract infections (LRTI, 32.2%) and chronic wet cough (9.4%). Lower airway malacia was the most common abnormal finding in these two groups (36.1% and 28.6%, respectively). BAL bacterial culture was positive in 55 children (39.6%) with recurrent LRTI and in 25 (59.5%) with chronic wet cough, being Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis the microorganisms most commonly isolated. FB proved a safe procedure and was well tolerated. CONCLUSIONS Pediatric FB is an essential tool at our tertiary pediatric respiratory center. It helps establish the anatomical conditions underlying several chronic respiratory conditions and any correlated microbiological findings, with a significant impact on further patient management.
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Affiliation(s)
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Diana Stabinger
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Andrea Zamunaro
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Stefania Zanconato
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - Silvia Carraro
- Department of Women's and Children's Health, University of Padova, Padua, Italy
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Prime SJ, Carter HE, McPhail SM, Petsky HL, Chang AB, Graves N, Marchant JM. Chronic wet cough in Australian children: Societal costs and quality of life. Pediatr Pulmonol 2021; 56:2707-2716. [PMID: 33939893 DOI: 10.1002/ppul.25438] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children with chronic wet cough regularly use the health system, experience considerable variability in care, have reduced quality of life (QoL), and, left untreated, poorer health outcomes. Despite this, little is known about the associated economic burden. This study aimed to quantify the cost of chronic wet cough among Australian children from the perspectives of families and the health system. METHODS A cost of illness study was conducted at the Queensland Children's Hospital, Brisbane, using data on 91 children newly referred to a respiratory specialist between July 2015 and January 2017 with a history of chronic wet cough (>4 weeks) of unknown etiology. Administrative and parent-reported data were used to estimate costs (reported in 2019 Australian Dollars [AUD]) for up to 12 months before and following initial pulmonology consultation. QoL was assessed for the same periods. RESULTS Mean cost per child-month during the average 9.8 months of observation preceding pulmonology consultation was AUD689 (95% confidence interval [CI] 534-844) increasing to AUD1339 (95% CI 1051-1628) during the average 11.9 months following pulmonology consultation. This translated to a total of AUD1.9 million across the study period, with families bearing 26.4% of costs. Aspiration and bronchiectasis were associated with higher total costs. For all etiologies, cough-specific QoL improved following pulmonology consultation, while direct medical costs declined. CONCLUSION Childhood chronic wet cough is associated with substantial societal costs. The observed cost decrease after specialist diagnosis suggests that early referral to a respiratory specialist may have economic benefits, in addition to the known health benefits.
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Affiliation(s)
- Samantha J Prime
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University and Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Nicholas Graves
- Health Service and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Julie M Marchant
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Dangor Z, Verwey C, Lala SG, Mabaso T, Mopeli K, Parris D, Gray DM, Chang AB, Zar HJ. Lower Respiratory Tract Infection in Children: When Are Further Investigations Warranted? Front Pediatr 2021; 9:708100. [PMID: 34395346 PMCID: PMC8356913 DOI: 10.3389/fped.2021.708100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Theodore Mabaso
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Keketso Mopeli
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Parris
- Department of Paeditrics, University of Pretoria, Pretoria, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Li Q, Guo Z, Li Y, Zhang G, Tian X, Gu R, Luo Z. Diagnosis and management of protracted bacterial bronchitis: a survey of Chinese pediatricians. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:46. [PMID: 33553339 PMCID: PMC7859824 DOI: 10.21037/atm-20-3984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children. However, it is often misdiagnosed and inappropriately treated in clinical practices. This study aims to investigate the current diagnosis and management of PBB among Chinese pediatricians. METHODS An electronic questionnaire designed to assess the diagnosis and management of PBB was sent to pediatricians in China. RESULTS A total of 1,022 pediatricians completed the questionnaire. Most (68.8%) of the pediatricians diagnosed PBB in compliance with the guidelines, 44.3% and 24.5% of them followed microbiology-based and clinical-based diagnosis criteria, respectively. Only 40.4% of the pediatricians chose amoxicillin-clavulanate as the first-line antibiotic for PBB treatment, 23.7% and 23.5% of them chose third-generation cephalosporins and macrolides, respectively. The majority of pediatricians (75.4%) reported 2-4 weeks of antibiotics course, 19.3% of them prescribed a shorter course and 5% of them selected a longer course. Only 26.3% of the pediatricians performed combined investigations of chest high-resolution computed tomography scan (c-HRCT), bronchoscopy, and immunological tests for recurrences of PBB. Compared with general pediatricians (GP), pediatric pulmonologists (PP) preferred microbiology-based diagnosis criteria, prescribed more amoxicillin-clavulanate, and performed more investigations for recurrent patients (P<0.05). CONCLUSIONS The majority of Chinese pediatricians diagnosed PBB in compliance with guidelines. However, the reasonable antibiotics applications and the investigations for recurrent PBB need to be improved.
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Affiliation(s)
| | | | - Yuanyuan Li
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guangli Zhang
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoyin Tian
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ruixue Gu
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Sørensen KG, Mikalsen IB, Neven A, Øymar K. Half of children with recurrent or chronic wet cough before three years of age were symptom-free by age seven. Acta Paediatr 2020; 109:2664-2670. [PMID: 32271955 DOI: 10.1111/apa.15293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
AIM We aimed to study the natural course of recurrent episodic and chronic wet cough in preschool children, the proportion and age of resolution, and risk factors for persistent symptoms. METHODS Parents of children with recurrent or chronic wet cough who had attended the outpatient clinic before the age of three years during 2010-2013 at Stavanger University Hospital, Norway, answered a questionnaire regarding clinical symptoms and current medication at a follow-up in 2017-2018. RESULTS We invited 840 children to participate, and parents consented for 348 (41.4%) of the children. At the first outpatient visit, 171 children (58.8%) had recurrent episodic and 120 (41.2%) had chronic wet cough. At follow-up at a median age of 82 months, 57.0% in both groups were symptom-free, and 9.4% with episodic cough and 13.3% with chronic cough had more than mild symptoms. During the last 12 months prior to the survey, 27.2% with episodic cough and 18.6% with chronic cough had used inhaled corticosteroids. CONCLUSION Half of the preschool children with recurrent episodic or chronic wet cough outgrew their symptoms by the median age of seven years, but one in four still used inhaled corticosteroids.
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Affiliation(s)
- Karen Galta Sørensen
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Ingvild Bruun Mikalsen
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Axel Neven
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
| | - Knut Øymar
- Department of Paediatrics Stavanger University Hospital Stavanger Norway
- Department of Clinical Science University of Bergen Bergen Norway
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Gross-Hodge E, Carroll WD, Rainford N, Gamble C, Gilchrist FJ. Duration of initial antibiotic course is associated with recurrent relapse in protracted bacterial bronchitis. Arch Dis Child 2020; 105:1111-1113. [PMID: 31624061 DOI: 10.1136/archdischild-2019-317917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Protracted bacterial bronchitis (PBB) is the leading cause of chronic wet cough in young children from developed countries. Despite its high prevalence there is a paucity of evidence to inform the optimal duration of treatment leading to variation in practice. Relapse of chronic cough is common and recurrent PBB (>3 episodes in 12 months) is associated with a future diagnosis of bronchiectasis. We investigated the factors associated with any relapse (≥1 episode in 12 months) and recurrent PBB in 66 children. No factor was significantly associated with any relapse. Duration of initial antibiotic treatment was the only factor significantly associated with recurrent PBB. Those who received antibiotics for 6 weeks antibiotics were less likely to develop recurrent PBB than those who received for 2 weeks (p=0.046). This is the first study to show an association between duration of initial antibiotic course and therefore future bronchiectasis. Prospective studies are needed to investigate this association.
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Affiliation(s)
| | - Will D Carroll
- University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | | | | | - Francis J Gilchrist
- Institute of Applied Clinical Science, Keele University, Keele, UK .,Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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41
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Ruffles TJC, Marchant JM, Masters IB, Yerkovich ST, Wurzel DF, Gibson PG, Busch G, Baines KJ, Simpson JL, Smith-Vaughan HC, Pizzutto SJ, Buntain HM, Hodge G, Hodge S, Upham JW, Chang AB. Outcomes of protracted bacterial bronchitis in children: A 5-year prospective cohort study. Respirology 2020; 26:241-248. [PMID: 33045125 DOI: 10.1111/resp.13950] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-term data on children with PBB has been identified as a research priority. We describe the 5-year outcomes for children with PBB to ascertain the presence of chronic respiratory disease (bronchiectasis, recurrent PBB and asthma) and identify the risk factors for these. METHODS Prospective cohort study was undertaken at the Queensland Children's Hospital, Brisbane, Australia, of 166 children with PBB and 28 controls (undergoing bronchoscopy for symptoms other than chronic wet cough). Monitoring was by monthly contact via research staff. Clinical review, spirometry and CT chest were performed as clinically indicated. RESULTS A total of 194 children were included in the analysis. Median duration of follow-up was 59 months (IQR: 50-71 months) post-index PBB episode, 67.5% had ongoing symptoms and 9.6% had bronchiectasis. Significant predictors of bronchiectasis were recurrent PBB in year 1 of follow-up (ORadj = 9.6, 95% CI: 1.8-50.1) and the presence of Haemophilus influenzae in the BAL (ORadj = 5.1, 95% CI: 1.4-19.1). Clinician-diagnosed asthma at final follow-up was present in 27.1% of children with PBB. A significant BDR (FEV1 improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen-specific IgE (ORadj = 14.8, 95% CI: 2.2-100.8) at baseline and bronchomalacia (ORadj = 5.9, 95% CI: 1.2-29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. CONCLUSION As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required.
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Affiliation(s)
- Tom J C Ruffles
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Academic Department of Paediatrics, The Royal Alexandra Children's Hospital, Brighton and Sussex Medical School, Brighton, UK
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ian B Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Danielle F Wurzel
- Infection and Immunity, Murdoch Children's Research Institute; Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Greta Busch
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen M Buntain
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - John W Upham
- The University of Queensland Diamantina Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Chellew N, Chang AB, Grimwood K. Azithromycin Prescribing by Respiratory Pediatricians in Australia and New Zealand for Chronic Wet Cough: A Questionnaire-Based Survey. Front Pediatr 2020; 8:519. [PMID: 32984223 PMCID: PMC7492546 DOI: 10.3389/fped.2020.00519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022] Open
Abstract
Aims: To determine how respiratory pediatricians across Australia and New Zealand prescribe azithromycin for children with chronic wet cough, including recurrent protracted bacterial bronchitis, chronic suppurative lung disease (CSLD) and bronchiectasis. Methods: A prospective web-based questionnaire was emailed to members of the Pediatric Special Interest Group of the Thoracic Society of Australia and New Zealand (TSANZ) between April and May 2018. It comprised eight demographic and 15 clinically focused questions. Results: Of the 73 respiratory pediatricians listed across Australia and New Zealand, 29 (40%) responded and all prescribed azithromycin for chronic wet cough. Twelve (41%) indicated that they would consider prescribing a short-course (2-4 weeks) of azithromycin for children with a chronic wet cough. Although most respondents reported prescribing long-term (>4-weeks) azithromycin for either CSLD (n = 23, 79%) or bronchiectasis (n = 24, 83%), only nine (31%) respondents would commence treatment if in the previous 12-months these children experienced three non-hospitalized exacerbations and just 12 (41%) would do so if there had been two hospitalisations for severe exacerbations during the same period in accordance with the TSANZ national guidelines. A lower threshold for prescribing azithromycin was described for Indigenous children or if co-morbidities were present. None prescribed azithromycin for >24-months. Macrolide-resistance was reported in Streptococcus pneumoniae and Staphylococcus aureus. Conclusion: Although Australian and New Zealand respiratory pediatricians in this survey prescribed azithromycin for chronic wet cough most often in children with either CSLD or bronchiectasis, many did so outside the current national guidelines. Reasons for this need exploring.
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Affiliation(s)
- Naomi Chellew
- Department of Paediatrics, Gold Coast Health, Southport, QLD, Australia
| | - Anne B. Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- Department of Paediatrics, Gold Coast Health, Southport, QLD, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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Brouard J, Vallet C, Marie J, Faucon C. Les séquelles de virose en pneumopédiatrie. PERFECTIONNEMENT EN PÉDIATRIE 2020. [PMCID: PMC7170799 DOI: 10.1016/j.perped.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
L’immaturité du système immunitaire explique une part de la vulnérabilité aux pathogènes respiratoires durant l’enfance. Une infection virale respiratoire aiguë chez l’enfant peut être secondaire à 1 des 200 virus génétiquement différents et identifiables par les outils moléculaires. Les cellules ciliées distribuées tout au long de l’épithélium des voies respiratoires sont la cible des virus. Les études épidémiologiques rapportent une diminution de la fonction respiratoire chez l’adulte indépendamment de facteurs confondants lorsqu’une pneumonie est survenue avant l’âge de 2 voire 7 ans. Cette réduction de la fonction respiratoire est le reflet probable de l’atteinte initiale malgré les processus de réparation (altération potentielle de croissance pulmonaire) et à l’âge adulte d’une accélération du déclin physiologique des capacités ventilatoires. Les études portant sur l’origine des dilatations des bronches retrouvent des antécédents de pneumopathies infectieuses plus d’une fois sur deux. Les infections à adénovirus sont particulièrement en cause. Une bronchiolite obstructive post-infectieuse peut survenir même chez l’enfant immunocompétent ; le tableau initial est très souvent pseudo-grippal, puis est marqué par une dissociation entre des signes fonctionnels importants et un examen clinique pauvre. L’évolution au long cours est peu prévisible mais peut conduire à l’insuffisance respiratoire chronique létale. Les pneumopathies infiltratives diffuses sont caractérisées par une infiltration diffuse de la charpente conjonctivale du poumon par des cellules inflammatoires et de la fibrose. Le rôle des virus dans son développement a été évoqué en raison de la présence d’inclusions cellulaires évoquant des particules virales dans le poumon d’enfants atteints. Enfin la plupart des études épidémiologiques soulignent l’association entre une symptomatologie sifflante secondaire à une agression virale durant l’enfance et le risque ultérieur de développement d’un asthme.
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Shteinberg M, Flume PA, Chalmers JD. Is bronchiectasis really a disease? Eur Respir Rev 2020; 29:29/155/190051. [PMID: 31996354 DOI: 10.1183/16000617.0051-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/31/2019] [Indexed: 11/05/2022] Open
Abstract
The definition of a disease requires that distinguishing signs and symptoms are present that are common, and that the constellation of signs and symptoms differentiate the condition from other causes. In bronchiectasis, anatomical changes, airways inflammation and airway infection are the distinguishing features that are common to this disease. However, bronchiectasis is a heterogenous disease: signs and symptoms are shared with other airway diseases, there are multiple aetiologies and certain phenotypes of bronchiectasis have distinct clinical and laboratory features that are not common to all people with bronchiectasis. Furthermore, response to therapeutic interventions in clinical trials is not uniform. The concept of bronchiectasis as a treatable trait has been suggested, but this may be too restrictive in view of the heterogeneity of bronchiectasis. It is our opinion that bronchiectasis should be defined as a disease in its own right, but one that shares several pathophysiological features and "treatable traits" with other airway diseases. These traits define the large heterogeneity in the pathogenesis and clinical features and suggest a more targeted approach to therapy.
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Affiliation(s)
- Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel .,Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Patrick A Flume
- Dept of Medicine and Dept of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Abstract
BACKGROUND Chronic cough is a common symptom in children and protracted bacterial bronchitis (PBB) is one of the causes of chronic cough. However, the understanding of this disease remains limited. The present study aims to update PBB in children. METHODS The clinical data of children with PBB from 2014 to 2018 were retrospectively analyzed, and PBB clinical features of published studies were summarized. Electronic databases were searched in May 2019. Clinical studies were included in the present study. Reviews were undertaken in duplicate. RESULTS Totally 712 cases were analyzed in this study, including 52 cases in our center and 660 cases from 14 studies. In the 52 cases, 88.5% of patients with PBB were less than 6 years old and all of them complained of wet cough. Three cases were confirmed with laryngomalacia, and microbiologically-based-PBB were identified in 13 cases (9 Streptococcus pneumonia, 3 Staphylococcus aureus, and 1 Pseudomonas aeruginosa). Twenty cases were completely remitted after treatment. In the 14 studies, the patients with PBB were typically younger than 3 years old, accompanying wheezing and airway malacia. Co-infection was common in most western cases, Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis were the top three pathogens. Symptoms were improved in most patients, whereas some cases with comorbidities required prolonged antibiotics treatment. CONCLUSIONS PBB is common in male infants with chronic wet cough and accompanied by wheezing and airway deformities. Most cases are clinically diagnosed PBB in China and microbiologically-based-PBB is common in western countries. Co-infection could be found, Streptococcus pneumoniae and Haemophilus influenza were the most frequent etiology in China and western countries, respectively. Patients with comorbidities may need extended antibiotics treatment for more than 2 weeks.
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Affiliation(s)
- Xiao-Bo Zhang
- Pediatric Department, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiao Wu
- Pediatric Department, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Guang-Min Nong
- Pediatric Department, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Nathan AM, Teh CSJ, Eg KP, Jabar KA, Zaki R, Hng SY, Westerhout C, Thavagnanam S, de Bruyne JA. Respiratory sequelae and quality of life in children one-year after being admitted with a lower respiratory tract infection: A prospective cohort study from a developing country. Pediatr Pulmonol 2020; 55:407-417. [PMID: 31846223 DOI: 10.1002/ppul.24598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/29/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Respiratory tract infections in children can result in respiratory sequelae. We aimed to determine the prevalence of, and factors associated with persistent respiratory sequelae 1 year after admission for a lower respiratory tract infection (LRTI). METHODOLOGY This prospective cohort study involved children 1 month to 5-years-old admitted with an LRTI. Children with asthma were excluded. Patients were reviewed at 1-, 6-, and 12-months post-hospital discharge. The parent cough-specific quality of life, the depression, anxiety, and stress scale questionnaire and cough diary for 1 month, were administered. Outcomes reviewed were number of unscheduled healthcare visits, respiratory symptoms and final respiratory diagnosis at 6 and/or 12 month-review by pediatric pulmonologists. RESULTS Three hundred patients with a mean ± SD age of 14 ± 15 months old were recruited. After 1 month, 239 (79.7%) returned: 28.5% (n = 68/239) had sought medical advice and 18% (n = 43/239) had cough at clinic review. Children who received antibiotics in hospital had significantly lower total cough scores (P = .005) as per the cough diary. After 1 year, 26% (n = 78/300) had a respiratory problem, predominantly preschool wheezing phenotype (n = 64/78, 82.1%). Three children had bronchiectasis or bronchiolitis obliterans. The parent cough-specific quality of life (PCQOL) was significantly lower in children with respiratory sequelae (P < .01). In logistic regression, the use of antibiotics in hospitals (adjusted odds ratio, 0.46; P = .005) was associated with reduced risk of respiratory sequelae. CONCLUSION In children admitted for LRTI, a quarter had respiratory sequelae, of which preschool wheeze was the commonest. The use of antibiotics was associated with a lower risk of respiratory sequelae.
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Affiliation(s)
- Anna M Nathan
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Cindy S J Teh
- Department of Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Kartini A Jabar
- Department of Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Rafdzah Zaki
- Department of Social & Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, Kuala Lumpur, Malaysia
| | - Shih Ying Hng
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia
| | - Caroline Westerhout
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Surendran Thavagnanam
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Jessie A de Bruyne
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
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47
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Gallucci M, Pedretti M, Giannetti A, di Palmo E, Bertelli L, Pession A, Ricci G. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr 2020; 8:433. [PMID: 32850546 PMCID: PMC7426454 DOI: 10.3389/fped.2020.00433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic cough is defined as a daily cough that persists longer than 4 weeks. Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.
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Affiliation(s)
- Marcella Gallucci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Melissa Pedretti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arianna Giannetti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Bertelli
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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48
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Laird P, Totterdell J, Walker R, Chang AB, Schultz A. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children. ERJ Open Res 2019; 5:00248-2019. [PMID: 31832431 PMCID: PMC6899340 DOI: 10.1183/23120541.00248-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Chronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia. Methods A whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics). Results Of the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%). Conclusion Given the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children in remote, north Western Australia is high. There is a need to implement strategies to detect and manage these entities and measure prevalence in other settings.http://bit.ly/33QLzDA
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Affiliation(s)
- Pamela Laird
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,Dept of Physiotherapy, Perth Children's Hospital, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia
| | - James Totterdell
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia
| | - Roz Walker
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia
| | - André Schultz
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia.,Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia
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49
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Wong OY, Marchant JM, Yerkovich ST, Chang AB. Predictors of time to cough resolution in children with chronic wet cough treated with antibiotics after bronchoscopy. Pediatr Pulmonol 2019; 54:1997-2002. [PMID: 31496125 DOI: 10.1002/ppul.24506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/21/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic wet cough is common in pediatric pulmonology practice and is clinically important. Guidelines recommend treatment with antibiotics as their effectiveness has been proven. However, factors associated with duration of cough in response to antibiotics in children with chronic wet cough have not been prospectively examined. OBJECTIVE To determine if demographic, clinical and/or bronchoalveolar lavage (BAL) factors are associated with "time to cough resolution" in children with chronic wet cough treated with antibiotics after bronchoscopy. METHODS Data from children with chronic wet cough treated with antibiotics after bronchoscopy were extracted from a prospective cohort study database. Cough dairies were used to determine when the cough resolved. Associations between various factors with "time to cough resolution" were examined using regression. RESULTS The median age of the 133 children was 2.4 years (interquartile range, 1.4-4.9). Duration of prior cough at bronchoscopy was significantly positively related with "time to cough resolution" (β = .010; 95% confidence interval, 0.004-0.017; P = .002). This translated to; for each month of prior cough, it took an extra 1.02 days to achieve cough resolution while on antibiotic treatment. Gender, age, diagnosis, tobacco smoke exposure, pneumonia history, blood cellularity, and BAL cellular and microbiology profiles were not significantly associated with time to cough resolution. CONCLUSION In children with chronic wet cough, duration of cough before antibiotic treatment is a small but significant determinant of "time to cough resolution." Research using standardized antibiotic regimes is required to provide clinical and/or biomarkers that can further identify factors associated with the response of chronic cough to antibiotic treatment.
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Affiliation(s)
- Oi Yin Wong
- Department of Paediatric and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.,Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Anne B Chang
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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50
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Seidl E, Kiermeier H, Liebisch G, Ballmann M, Hesse S, Paul-Buck K, Ratjen F, Rietschel E, Griese M. Lavage lipidomics signatures in children with cystic fibrosis and protracted bacterial bronchitis. J Cyst Fibros 2019; 18:790-795. [DOI: 10.1016/j.jcf.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/08/2019] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
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