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Everard ML, Priftis K, Koumbourlis AC, Shields MD. Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology. Front Pediatr 2024; 12:1391290. [PMID: 38910961 PMCID: PMC11190372 DOI: 10.3389/fped.2024.1391290] [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: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024] Open
Abstract
In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to 'chronic obstructive pulmonary disease' (COPD) has minimally changed in recent decades while 'the incidence of bronchiectasis' is on the rise. The current focus on producing guidelines for these two airway 'diseases' has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as 'diseases'. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed 'persistent bacterial bronchitis' (PBB). This condition shares all the same characteristics as 'chronic bronchitis', which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.
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Affiliation(s)
- Mark L Everard
- Division of Paediatrics & Child Health, University of Western Australia, Perth, WA, Australia
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Michael D Shields
- Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
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2
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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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Wall LA, Wisner EL, Gipson KS, Sorensen RU. Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach. Front Immunol 2020; 11:522. [PMID: 32296433 PMCID: PMC7138103 DOI: 10.3389/fimmu.2020.00522] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
Bronchiectasis, the presence of bronchial wall thickening with airway dilatation, is a particularly challenging complication of primary antibody deficiencies. While susceptibility to infections may be the primary factor leading to the development of bronchiectasis in these patients, the condition may develop in the absence of known infections. Once bronchiectasis is present, the lungs are subject to a progressive cycle involving both infectious and non-infectious factors. If bronchiectasis is not identified or not managed appropriately, the cycle proceeds unchecked and yields advanced and permanent lung damage. Severe symptoms may limit exercise tolerance, require frequent hospitalizations, profoundly impair quality of life (QOL), and lead to early death. This review article focuses on the appropriate identification and management of bronchiectasis in patients with primary antibody deficiencies. The underlying immune deficiency and the bronchiectasis need to be treated from combined immunology and pulmonary perspectives, reflected in this review by experts from both fields. An aggressive multidisciplinary approach may reduce exacerbations and slow the progression of permanent lung damage.
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Affiliation(s)
- Luke A Wall
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States.,Children's Hospital of New Orleans, New Orleans, LA, United States
| | - Elizabeth L Wisner
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States.,Children's Hospital of New Orleans, New Orleans, LA, United States
| | - Kevin S Gipson
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ricardo U Sorensen
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
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4
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Nathan AM, Teh CSJ, Jabar KA, Teoh BT, Tangaperumal A, Westerhout C, Zaki R, Eg KP, Thavagnanam S, de Bruyne JA. Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study. PLoS One 2020; 15:e0228056. [PMID: 32059033 PMCID: PMC7021284 DOI: 10.1371/journal.pone.0228056] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Pneumonia in children is a common disease yet determining its aetiology remains elusive. Objectives To determine the a) aetiology, b) factors associated with bacterial pneumonia and c) association between co-infections (bacteria + virus) and severity of disease, in children admitted with severe pneumonia. Methods A prospective cohort study involving children aged 1-month to 5-years admitted with very severe pneumonia, as per the WHO definition, over 2 years. Induced sputum and blood obtained within 24 hrs of admission were examined via PCR, immunofluorescence and culture to detect 17 bacteria/viruses. A designated radiologist read the chest radiographs. Results Three hundred patients with a mean (SD) age of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in 25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were associated with bacterial infection. C-reactive protein (CRP) [p = 0.007]) was significantly higher in patients with co-infections but duration of hospitalization (p = 0.77) and requirement for supplemental respiratory support (p = 0.26) were not associated with co-infection. Conclusions Bacteria remain an important cause of very severe pneumonia in developing countries with one in four children admitted isolating bacteria alone. Male gender and presence of crepitations were significantly associated with bacterial aetiology. Co-infection was associated with a higher CRP but no other parameters of severe clinical illness.
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Affiliation(s)
- Anna Marie Nathan
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Boon Teong Teoh
- Department of Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Anithaa Tangaperumal
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Caroline Westerhout
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rafdzah Zaki
- Centre for Epidemiology and Evidence-Based Practice, Department of Social & Preventive Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Surendran Thavagnanam
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Jessie Anne de Bruyne
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
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5
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Beckeringh NI, Rutjes NW, van Schuppen J, Kuijpers TW. Noncystic Fibrosis Bronchiectasis: Evaluation of an Extensive Diagnostic Protocol in Determining Pediatric Lung Disease Etiology. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:155-162. [PMID: 32140286 DOI: 10.1089/ped.2019.1030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 10/06/2019] [Indexed: 12/21/2022]
Abstract
Introduction: Pediatric noncystic fibrosis (CF) bronchiectasis has a variety of causes. An early and accurate diagnosis may prevent disease progression and complications. Current diagnostics and yield regarding etiology are evaluated in a pediatric cohort at a tertiary referral center. Methods: Available data, including high-resolution computed tomography (HRCT) characteristics, microbiological testing, and immunological screening of all children diagnosed with non-CF bronchiectasis between 2003 and 2017, were evaluated. Results: In 91% of patients [n = 69; median age 9 (3-18 years)] etiology was established in the diagnostic process. Postinfection (29%) and immunodeficiency (29%) were most common, followed by congenital anomalies (10%), aspiration (7%), asthma (6%), and primary ciliary dyskinesia (1%). HRCT predominantly showed bilateral involvement in immunodeficient patients (85%) and those with idiopathic bronchiectasis (83%). Congenital malformations (71%) were associated with unilateral disease. Completion of the diagnostic process often led to a change of treatment as started after initial diagnosis. Conclusion: Using a comprehensive diagnostic protocol, the etiology of pediatric non-CF bronchiectasis was established in more than 90% of patients. HRCT provides additional diagnostic information as it points to either a more systemic or a more localized etiology. Adequate diagnostics and data analysis allow treatment to be specifically adapted to prevent disease progression.
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Affiliation(s)
- Nike I Beckeringh
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels W Rutjes
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Department of Pediatric Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Donnelly D, Everard ML. 'Dry' and 'wet' cough: how reliable is parental reporting? BMJ Open Respir Res 2019; 6:e000375. [PMID: 31178996 PMCID: PMC6530544 DOI: 10.1136/bmjresp-2018-000375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of 'wheeze' is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child's cough is likely to be accurate. Methods Parents of 48 'new' patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child's cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video. Results In a quarter of cases, the parents chose a video clip of a 'dry' or 'wet' cough having given the opposite description. In a further 20% parents chose examples of both 'dry' and 'wet' coughs despite having used only one descriptor. Discussion While the characteristics of a child's cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child's cough with some caution in that one person's 'dry' cough may very well be another person's 'wet' cough.
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Affiliation(s)
- Deirdre Donnelly
- Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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7
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Prime SJ, Marchant J, Chang AB, Petsky HL. Development of a quality improvement audit tool for the primary care of children with chronic wet cough using a modified Delphi consensus approach. J Paediatr Child Health 2019; 55:459-464. [PMID: 30251373 DOI: 10.1111/jpc.14229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/27/2018] [Indexed: 01/23/2023]
Abstract
AIM In the absence of quality indicators (QIs) for the management of chronic wet cough, our study's aim was to determine whether consensus on QIs reflecting good primary health care, prior to referral for children with chronic wet cough, can be achieved. METHODS A questionnaire consisting of 10 QIs was developed by a clinical working group based on current evidence and guidelines on the management of chronic wet cough in children. Each indicator reflected the quality of care provided to children with chronic wet cough in primary care prior to referral. A modified Delphi consensus questionnaire was undertaken involving expert paediatric respiratory clinicians and general paediatricians who graded the importance of each indicator for the purposes above. We a priori defined that consensus was considered achieved if >75% agreed on the indicator. RESULTS Twenty-two specialists (from Brisbane, Melbourne, Perth and Canberra) participated in the survey. The cumulative number of years of their respiratory experience was 324 and that of general clinical practice was 504. Consensus was achieved in all 10 QIs, with 6 reaching 100% agreement. Mean agreement for the 10 items was 97%. CONCLUSION As complete consensus was achieved on these QIs, it can be used as a provisional clinical audit tool and can guide the development of a robust audit tool for primary care clinical practice to assist with quality improvement initiatives.
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Affiliation(s)
- Samantha J Prime
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Marchant
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Helen L Petsky
- School of Nursing and Midwifery, Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
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8
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Chang AB, Redding GJ. Bronchiectasis and Chronic Suppurative Lung Disease. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7161398 DOI: 10.1016/b978-0-323-44887-1.00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Singh A, Bhalla AS, Jana M. Bronchiectasis Revisited: Imaging-Based Pattern Approach to Diagnosis. Curr Probl Diagn Radiol 2019. [DOI: 10.1067/j.cpradiol.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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10
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Regan KH, Hill AT. Emerging therapies in adult and paediatric bronchiectasis. Respirology 2018; 23:1127-1137. [DOI: 10.1111/resp.13407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/06/2018] [Accepted: 08/15/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Kate H. Regan
- University of Edinburgh/MRC Centre for Inflammation ResearchThe Queen's Medical Research Institute Edinburgh UK
- Department of Respiratory MedicineRoyal Infirmary of Edinburgh Edinburgh UK
| | - Adam T. Hill
- University of Edinburgh/MRC Centre for Inflammation ResearchThe Queen's Medical Research Institute Edinburgh UK
- Department of Respiratory MedicineRoyal Infirmary of Edinburgh Edinburgh UK
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11
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de Vries JJV, Chang AB, Marchant JM. Comparison of bronchoscopy and bronchoalveolar lavage findings in three types of suppurative lung disease. Pediatr Pulmonol 2018; 53:467-474. [PMID: 29405664 DOI: 10.1002/ppul.23952] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/30/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Endobronchial suppuration is present in children with protracted bacterial bronchitis (PBB), bronchiectasis, and cystic fibrosis (CF). However, no studies have directly compared bronchoscopy and bronchoalveolar lavage (BAL) findings across these conditions within a single center using the same techniques and with shared community pathogens. AIM To determine; (i) the bronchoscopic findings and BAL microbiology and cellularity among children with these conditions and; (ii) the relationship between bacterial pathogens, airway cellularity and aberrant macroscopic bronchoscopic findings. METHODS We retrospectively reviewed all bronchoscopy data (undertaken over 6.5-years) from our center in children (<6 years; n = 316) meeting definitions of PBB (n = 125), bronchiectasis (n = 138), and CF (n = 53). RESULTS The children's median age was 26-months (Interquartile range (IQR) = 16-43). Children with PBB and bronchiectasis had higher rates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae infection, whereas children with CF had frequent Pseudomonas aeruginosa and Staphylococcus aureus infections. Novel findings include detection of cytomegalovirus and Epstein-Barr virus (EBV) (by polymerase chain reaction) in children with PBB (26%, 17%, respectively) and bronchiectasis (27%, 29%). Median airway neutrophil percentage was significantly higher in CF (68%; IQR = 42-83) compared to PBB (36%; IQR = 18-68) and bronchiectasis (22%; IQR = 8-64) (P < 0.0001), despite lower rates of infection. Presence of malacia did not significantly impact on infection or inflammation. CONCLUSION In this first study to directly compare bronchoscopic data among young children with PBB, bronchiectasis, and CF, microbiological patterns of airway infections and neutrophilia varied. Our findings of cytomegalovirus and EBV detection in children with PBB and bronchiectasis require confirmation and further evaluation.
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Affiliation(s)
- Jorrit J V de Vries
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.,Children's Centre of Health Research, Queensland University of Technology, 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, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, 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, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
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Abstract
INTRODUCTION The prevalence and awareness of bronchiectasis not related to cystic fibrosis (CF) is increasing and it is now recognized as a major cause of respiratory morbidity, mortality and healthcare utilization worldwide. The need to elucidate the early origins of bronchiectasis is increasingly appreciated and has been identified as an important research priority. Current treatments for pediatric bronchiectasis are limited to antimicrobials, airway clearance techniques and vaccination. Several new drugs targeting airway inflammation are currently in development. Areas covered: Current management of pediatric bronchiectasis, including discussion on therapeutics, non-pharmacological interventions and preventative and surveillance strategies are covered in this review. We describe selected adult and pediatric data on bronchiectasis treatments and briefly discuss emerging therapeutics in the field. Expert commentary: Despite the burden of disease, the number of studies evaluating potential treatments for bronchiectasis in children is extremely low and substantially disproportionate to that for CF. Research into the interactions between early life respiratory tract infections and the developing immune system in children is likely to reveal risk factors for bronchiectasis development and inform future preventative and therapeutic strategies. Tailoring interventions to childhood bronchiectasis is imperative to halt the disease in its origins and improve adult outcomes.
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Affiliation(s)
- Danielle F Wurzel
- a The Royal Children's Hospital , Parkville , Australia.,b Murdoch Childrens Research Institute , Parkville , Australia
| | - Anne B Chang
- c Lady Cilento Children's Hospital , Queensland University of Technology , Brisbane , Australia.,d Menzies School of Health Research , Charles Darwin University , Darwin , Australia
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Abstract
Chronic cough in children is increasingly defined as a cough that lasts more than four weeks. It is recognized as a different entity than cough in adults. As a result, the diagnostic approach and management of chronic cough in children are no longer extrapolated from adult guidelines. These differences are attributed to the various characteristics of the respiratory tract, immunological system and nervous system in children. Specific paediatric guidelines and algorithms for chronic cough are now widely applied. Post-infectious cough, asthma, bronchiectasis, malacia and protracted bacterial bronchitis (PBB) appear to be the major causes of cough in young children. By adolescence, the causes of cough are more likely to be similar to those in adults, namely, gastroesophageal reflux, asthma, and upper airway syndrome. In a primary setting, it is essential to investigate the underlying disease entity that initiates and sustains chronic cough. The use of cough management protocols or algorithms improves clinical outcomes and should differ depending on the associated characteristics of the cough and the child's clinical history. Performing a thorough history and physical examination is crucial to starting an individualised approach. A correct interpretation of the phenotypic presentation can be translated into guidance for workup. This approach will be helpful for adequate management without the risk of inappropriate investigations or inadequate treatment.
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Affiliation(s)
- Ahmad Kantar
- Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy
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14
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Eg KP, Mirra V, Chang AB, Santamaria F. Editorial: Chronic Suppurative Lung Disease and Bronchiectasis in Children and Adolescents. Front Pediatr 2017; 5:196. [PMID: 28929095 PMCID: PMC5591788 DOI: 10.3389/fped.2017.00196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Kah Peng Eg
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Children's Centre for Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Children's Centre for Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, NT, Australia
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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15
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Bronchiectasis: shaking off its orphan status. THE LANCET RESPIRATORY MEDICINE 2016; 4:927-928. [DOI: 10.1016/s2213-2600(16)30370-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 11/22/2022]
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16
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Abstract
Chronic suppurative lung disease (CSLD), characterized by a bronchiectasis-like syndrome in the absence of bronchial dilatation, is well described in the pediatric literature. In some patients, it may be a precursor of bronchiectasis. In adults, this syndrome has not been well described. We present four adult patients without obvious causative exposures who presented with prolonged cough and purulent sputum. Sputum cultures revealed a variety of Gram negative bacteria, fungi and mycobacteria. High resolution CT scanning did not reveal bronchiectasis. Evaluation revealed underlying causes including immunodeficiency in two, and Mycobacterium avium infection. One patient subsequently developed bronchiectasis. All patients improved with therapy. CSLD occurs in adults and has characteristics that distinguish it from typical chronic bronchitis. These include the lack of causative environmental exposures and infection with unusual pathogens. Evaluation and treatment of these patients similar to bronchiectasis patients may lead to clinical improvement.
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Affiliation(s)
- Mark L Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Antranik Mangardich
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, USA
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17
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Hodge S, Upham JW, Pizzutto S, Petsky HL, Yerkovich S, Baines KJ, Gibson P, Simpson JL, Buntain H, Chen ACH, Hodge G, Chang AB. Is Alveolar Macrophage Phagocytic Dysfunction in Children With Protracted Bacterial Bronchitis a Forerunner to Bronchiectasis? Chest 2016; 149:508-515. [PMID: 26867834 DOI: 10.1016/j.chest.2015.10.066] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/11/2015] [Accepted: 10/15/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Children with recurrent protracted bacterial bronchitis (PBB) and bronchiectasis share common features, and PBB is likely a forerunner to bronchiectasis. Both diseases are associated with neutrophilic inflammation and frequent isolation of potentially pathogenic microorganisms, including nontypeable Haemophilus influenzae (NTHi), from the lower airway. Defective alveolar macrophage phagocytosis of apoptotic bronchial epithelial cells (efferocytosis), as found in other chronic lung diseases, may also contribute to tissue damage and neutrophil persistence. Thus, in children with bronchiectasis or PBB and in control subjects, we quantified the phagocytosis of airway apoptotic cells and NTHi by alveolar macrophages and related the phagocytic capacity to clinical and airway inflammation. METHODS Children with bronchiectasis (n = 55) or PBB (n = 13) and control subjects (n = 13) were recruited. Alveolar macrophage phagocytosis, efferocytosis, and expression of phagocytic scavenger receptors were assessed by flow cytometry. Bronchoalveolar lavage fluid interleukin (IL) 1β was measured by enzyme-linked immunosorbent assay. RESULTS For children with PBB or bronchiectasis, macrophage phagocytic capacity was significantly lower than for control subjects (P = .003 and P < .001 for efferocytosis and P = .041 and P = .004 for phagocytosis of NTHi; PBB and bronchiectasis, respectively); median phagocytosis of NTHi for the groups was as follows: bronchiectasis, 13.7% (interquartile range [IQR], 11%-16%); PBB, 16% (IQR, 11%-16%); control subjects, 19.0% (IQR, 13%-21%); and median efferocytosis for the groups was as follows: bronchiectasis, 14.1% (IQR, 10%-16%); PBB, 16.2% (IQR, 14%-17%); control subjects, 18.1% (IQR, 16%-21%). Mannose receptor expression was significantly reduced in the bronchiectasis group (P = .019), and IL-1β increased in both bronchiectasis and PBB groups vs control subjects. CONCLUSIONS A reduced alveolar macrophage phagocytic host response to apoptotic cells or NTHi may contribute to neutrophilic inflammation and NTHi colonization in both PBB and bronchiectasis. Whether this mechanism also contributes to the progression of PBB to bronchiectasis remains unknown.
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Affiliation(s)
- Sandra Hodge
- Chronic Inflammatory Lung Disease Research Laboratory, Lung Research Unit, Hanson Institute and Department of Thoracic Medicine, Royal Adelaide Hospital, and The School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - John W Upham
- Princess Alexandra Hospital, Brisbane, QLD, Australia; The School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen L Petsky
- Queensland University of Technology, South Brisbane, QLD, Australia
| | - Stephanie Yerkovich
- The School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Katherine J Baines
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter Gibson
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, NSW, Australia
| | - Jodie L Simpson
- Respiratory and Sleep Medicine, School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle, Callaghan, NSW, Australia
| | - Helen Buntain
- Queensland Children's Health Service, Brisbane, QLD, and Queensland Children's Medical Research Institute, Brisbane, QLD, Australia
| | - Alice C H Chen
- The School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Greg Hodge
- Chronic Inflammatory Lung Disease Research Laboratory, Lung Research Unit, Hanson Institute and Department of Thoracic Medicine, Royal Adelaide Hospital, and The School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Queensland Children's Health Service, Brisbane, QLD, and Queensland Children's Medical Research Institute, Brisbane, QLD, Australia
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18
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Patria MF, Longhi B, Lelii M, Tagliabue C, Lavelli M, Galeone C, Principi N, Esposito S. Children with recurrent pneumonia and non-cystic fibrosis bronchiectasis. Ital J Pediatr 2016; 42:13. [PMID: 26861259 PMCID: PMC4748602 DOI: 10.1186/s13052-016-0225-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent pneumonia (RP) is one of the most frequent causes of pediatric non-cystic fibrosis (CF) bronchiectasis (BE) and a consequent accelerated decline in lung function. The aim of this study was to analyse the clinical records of children with RP in attempt to identify factors that may lead to an early suspicion of non-CF BE. METHODS We recorded the demographic and clinical data, and lung function test results of children without CF attending our outpatient RP clinic between January 2009 to December 2013 who had undergone chest high-resolution computed tomography ≥ 8 weeks after an acute pneumonia episode and ≤ 6 months before enrolment. RESULTS The study involved 42 patients with RP: 21 with and 21 without non-CF BE. The most frequent underlying diseases in both groups were chronic rhinosinusitis with post-nasal drip and recurrent wheezing (81 % and 71.4 % of those with, and 85.7 % and 71.4 % of those without BE). FEV1 and FEF25-75 values were significantly lower in the children with non-CF BE than in those without (77.9 ± 17.8 vs 96.8 ± 12.4, p = 0.004; 69.3 ± 25.6 vs 89.3 ± 21.9, p = 0.048). Bronchodilator responsiveness was observed in seven children with BE (33.3 %) and two without (9.5 %; p = 0.13). CONCLUSIONS Reduced FEV1 and FEF25-75 values seem associated with an increased risk of developing non-CF BE in children with RP. This suggests a need for further studies to confirm the diagnostic usefulness use of spirometry in such cases.
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Affiliation(s)
- Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Benedetta Longhi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Marinella Lavelli
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy.
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
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19
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Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children With Chronic Wet or Productive Cough--Treatment and Investigations: A Systematic Review. Chest 2016; 149:120-42. [PMID: 26757284 DOI: 10.1378/chest.15-2065] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/14/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks' duration) wet or productive cough not related to bronchiectasis: KQ1-How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2-When should they be referred for further investigations? METHODS The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English. RESULTS Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95% CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations. CONCLUSIONS There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland Uni of Technology, Children's Health Queensland, Queensland, Australia.
| | - John J Oppenheimer
- New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ
| | - Miles Weinberger
- Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
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20
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Slack MPE. A review of the role of Haemophilus influenzae in community-acquired pneumonia. Pneumonia (Nathan) 2015; 6:26-43. [PMID: 31641576 PMCID: PMC5922337 DOI: 10.15172/pneu.2015.6/520] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/04/2015] [Indexed: 01/01/2023] Open
Abstract
In an era when Haemophilus influenzae type b (Hib) conjugate vaccine is widely used, the incidence of Hib as a cause of community-acquired pneumonia (CAP) has dramatcally declined. Non-typeable H. influenzae (NTHi) strains and, occasionally, other encapsulated serotypes of H. influenzae are now the cause of the majority of invasive H. influenzae infectons, including bacteraemic CAP. NTHi have long been recognised as an important cause of lower respiratory tract infecton, including pneumonia, in adults, especially those with underlying diseases. The role of NTHi as a cause of non-bacteraemic CAP in children is less clear. In this review the evidence for the role of NTHi and capsulated strains of H. influenzae will be examined.
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Affiliation(s)
- Mary P E Slack
- 15Gold Coast Campus, Griffith University, Queensland, Australia.,25Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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21
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Abstract
Despite the high prevalence of cough in children, the topic has been poorly researched. Although pediatricians recognize that chronic cough in children is different from that in adults, this difference seems less recognizable to other health professionals. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. Additionally, immunological responses undergo developmental and memorial processes that make infection and congenital abnormalities the overwhelming cause of cough in children. The lack of comprehensive clinical data regarding chronic cough in children has initially required pediatricians to adopt an adult approach to the problem. In the last 10 years, however, research has led to the reconsideration of the etiology of chronic cough in children. Currently, attention has focused on protracted bacterial bronchitis as a major cause of chronic cough in preschool-aged children and as a possible precursor of bronchiectasis. New research horizons are emerging for both the treatment and prevention of particular causes of chronic cough in children.
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Affiliation(s)
- Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, via Forlanini 15, Ponte San Pietro-Bergamo, 24036, Bergamo, Italy.
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22
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Panagiotopoulou EC, Fouzas S, Douros K, Triantaphyllidou IE, Malavaki C, Priftis KN, Karamanos NK, Anthracopoulos MB. Increased β-glucuronidase activity in bronchoalveolar lavage fluid of children with bacterial lung infection: A case-control study. Respirology 2015; 20:1248-54. [PMID: 26172956 DOI: 10.1111/resp.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/04/2015] [Accepted: 04/26/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE β-Glucuronidase is a lysosomal enzyme released into the extracellular fluid during inflammation. Increased β-glucuronidase activity in the cerebrospinal and peritoneal fluid has been shown to be a useful marker of bacterial inflammation. We explored the role of β-glucuronidase in the detection of bacterial infection in bronchoalveolar lavage fluid (BALF) of paediatric patients. METHODS In this case-control study, % polymorphonuclear cell count (PMN%), β-glucuronidase activity, interleukin-8 (IL-8), tumour necrosis factor-α (TNF-α) and elastase were measured in culture-positive (≥10(4) cfu/mL, C+) and -negative (C-) BALF samples obtained from children. RESULTS A total of 92 BALF samples were analysed. The median β-glucuronidase activity (measured in nanomoles of 4-methylumbelliferone (4-MU)/mL BALF/h) was 246.4 in C+ (interquartile range: 71.2-751) and 21.9 in C- (4.0-40.8) (P < 0.001). The levels of TNF-α and IL-8 were increased in C+ as compared with C- (5.4 (1.7-12.6) vs 0.7 (0.2-6.2) pg/mL, P < 0.001 and 288 (76-4300) vs 287 (89-1566) pg/mL, P = 0.042, respectively). Elastase level and PMN% did not differ significantly (50 (21-149) vs 26 (15-59) ng/mL, P = 0.051 and 20 (9-40) vs 18 (9-34) %, P = 0.674, respectively). The area under the curve of β-glucuronidase activity (0.856, 95% confidence interval (CI): 0.767-0.920) was higher than that of TNF-α (0.718; 95% CI: 0.614-0.806; P = 0.040), IL-8 (0.623; 95% CI: 0.516-0.722; P = 0.001), elastase (0.645; 95% CI: 0.514-0.761; P = 0.008) and PMN% (0.526; 95 % CI: 0.418-0.632; P < 0.001). CONCLUSIONS This study demonstrates a significant increase of β-glucuronidase activity in BALF of children with culture-positive bacterial inflammation. In our population β-glucuronidase activity showed superior predictive ability for bacterial lung infection than other markers of inflammation.
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Affiliation(s)
- Evgenia C Panagiotopoulou
- Respiratory Unit, Department of Paediatrics, University General Hospital of Patras, Rion-Patras, Greece
| | - Sotirios Fouzas
- Respiratory Unit, Department of Paediatrics, University General Hospital of Patras, Rion-Patras, Greece.,Paediatric Pulmonology and Allergy Research Group, University of Patras, Rion-Patras, Greece
| | - Konstantinos Douros
- Respiratory and Allergy Unit, Third Department of Paediatrics, 'Attikon' University General Hospital, Athens, Greece
| | - Irene-Eva Triantaphyllidou
- Biochemistry, Biochemical Analysis, Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Rion-Patras, Greece
| | - Christina Malavaki
- Biochemistry, Biochemical Analysis, Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Rion-Patras, Greece
| | - Kostas N Priftis
- Paediatric Pulmonology and Allergy Research Group, University of Patras, Rion-Patras, Greece.,Respiratory and Allergy Unit, Third Department of Paediatrics, 'Attikon' University General Hospital, Athens, Greece.,Department of Allergology-Pulmonology, Penteli Children's Hospital, Athens, Greece
| | - Nikos K Karamanos
- Biochemistry, Biochemical Analysis, Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Rion-Patras, Greece
| | - Michael B Anthracopoulos
- Respiratory Unit, Department of Paediatrics, University General Hospital of Patras, Rion-Patras, Greece.,Paediatric Pulmonology and Allergy Research Group, University of Patras, Rion-Patras, Greece
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23
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High Pulmonary Levels of IL-6 and IL-1β in Children with Chronic Suppurative Lung Disease Are Associated with Low Systemic IFN-γ Production in Response to Non-Typeable Haemophilus influenzae. PLoS One 2015; 10:e0129517. [PMID: 26066058 PMCID: PMC4466570 DOI: 10.1371/journal.pone.0129517] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/08/2015] [Indexed: 11/22/2022] Open
Abstract
Non-typeable Haemophilus influenzae (NTHi) is commonly associated with chronic suppurative lung disease in children. We have previously shown that children with chronic suppurative lung disease have a reduced capacity to produce IFN-γ in response to NTHi compared with healthy control children. The aim of this study was to determine if deficient NTHi-specific IFN-γ production is associated with heightened systemic or airway inflammation. We measured a panel of cytokines (IFN-γ, IL-1β, IL-6, IL-8, IL-12 p70), antimicrobial proteins (LL-37, IP-10) as well as cellular and clinical factors associated with airway and systemic inflammation in 70 children with chronic suppurative lung disease. IFN-γ was measured in peripheral blood mononuclear cells challenged in vitro with live NTHi. Regression analysis was used to assess the association between the systemic and airway inflammation and the capacity to produce IFN-γ. On multivariate regression, NTHi-specific IFN-γ production was significantly negatively associated with the BAL concentrations of the inflammatory cytokines IL-6 (β=-0.316; 95%CI -0.49, -0.14; p=0.001) and IL-1β (β=-0.023; 95%CI -0.04, -0.01; p=0.001). This association was independent of bacterial or viral infection, BAL cellularity and the severity of bronchiectasis (using modified Bhalla score on chest CT scans). We found limited evidence of systemic inflammation in children with chronic suppurative lung disease. In summary, increased local airway inflammation is associated with a poorer systemic cell-mediated immune response to NTHi in children with chronic suppurative lung disease. These data support the emerging body of evidence that impaired cell-mediated immune responses and dysregulated airway inflammation may be linked and contribute to the pathobiology of chronic suppurative lung disease.
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24
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Chang AB, Bell SC, Torzillo PJ, King PT, Maguire GP, Byrnes CA, Holland AE, O'Mara P, Grimwood K. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust 2015; 202:21-3. [PMID: 25588439 DOI: 10.5694/mja14.00287] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 10/09/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Anne B Chang
- Queensland Children's Medical Research Institute, Brisbane, QLD, Australia.
| | - Scott C Bell
- Prince Charles Hospital, Brisbane, QLD, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital Medical Centre, Sydney, NSW, Australia
| | - Paul T King
- Monash Medical Centre, Melbourne, VIC, Australia
| | | | | | | | - Peter O'Mara
- University of Newcastle, Newcastle, NSW, Australia
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25
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Chang AB, Marsh RL, Smith-Vaughan HC, Hoffman LR. Emerging drugs for bronchiectasis: an update. Expert Opin Emerg Drugs 2015; 20:277-97. [DOI: 10.1517/14728214.2015.1021683] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Marsh RL, Thornton RB, Smith-Vaughan HC, Richmond P, Pizzutto SJ, Chang AB. Detection of biofilm in bronchoalveolar lavage from children with non-cystic fibrosis bronchiectasis. Pediatr Pulmonol 2015; 50:284-292. [PMID: 24644254 DOI: 10.1002/ppul.23031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 02/03/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The presence of Pseudomonas aeruginosa biofilms in lower airway specimens from cystic fibrosis (CF) patients is well established. To date, biofilm has not been demonstrated in bronchoalveolar lavage (BAL) from people with non-CF bronchiectasis. The aim of this study was to determine (i) if biofilm was present in BAL from children with and without bronchiectasis, and (ii) if biofilm detection differed between sequentially collected BAL. METHODS Testing for biofilm in two sequentially collected BAL from children with and without bronchiectasis was done using BacLight™ live-dead staining and lectin staining for extracellular polymeric biofilm matrices. Bacterial culture and cytological measures were performed on the first and second lavages, respectively. Clinically important BAL infection was defined as >104 cfu of respiratory pathogens/ml BAL. RESULTS Biofilm was detected in BAL from seven of eight (87.5%) children with bronchiectasis (aged 0.8-6.9 years), but was not detected in any of three controls (aged 1.3-8.6 years). The biofilms contained both live and dead bacteria irrespective of antibiotic use prior to bronchoscopy. Biofilm was detected more frequently in the second lavage than the first. Three of the seven biofilm-positive BAL were culture-positive for respiratory pathogens at clinically important levels. CONCLUSIONS Biofilm is present in BAL from children with non-CF bronchiectasis even when BAL-defined clinically important infection was absent. Studies to characterize lower airway biofilms and determine how biofilm contributes to bronchiectasis disease progression and treatment outcomes are necessary. Pediatr Pulmonol. 2015; 50:284-292. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Robyn L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ruth B Thornton
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Western Australia, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Western Australia, Australia
| | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia
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27
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Chang AB, Marsh RL, Upham JW, Hoffman LR, Smith-Vaughan H, Holt D, Toombs M, Byrnes C, Yerkovich ST, Torzillo PJ, O'Grady KAF, Grimwood K. Toward making inroads in reducing the disparity of lung health in Australian indigenous and new zealand māori children. Front Pediatr 2015; 3:9. [PMID: 25741502 PMCID: PMC4327127 DOI: 10.3389/fped.2015.00009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/26/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia
| | - Robyn L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital , Brisbane, QLD , Australia ; School of Medicine, The University of Queensland , Brisbane, QLD , Australia
| | - Lucas R Hoffman
- Department of Pediatrics, University of Washington , Seattle, WA , USA ; Department of Microbiology, University of Washington , Seattle, WA , USA
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Deborah Holt
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Maree Toombs
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Indigenous Health, Toowoomba Rural Clinical School, The University of Queensland , Toowoomba, QLD , Australia
| | - Catherine Byrnes
- Paediatric Department, University of Auckland & Starship Children's Hospital , Auckland , New Zealand
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; School of Medicine, The University of Queensland , Brisbane, QLD , Australia ; Queensland Lung Transplant Service, The Prince Charles Hospital , Chermside, QLD , Australia
| | - Paul J Torzillo
- Nganampa Health Council, Alice Springs and Royal Prince Alfred Hospital, The University of Sydney , Sydney, NSW , Australia
| | - Kerry-Ann F O'Grady
- Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia
| | - Keith Grimwood
- Gold Coast University Hospital, Griffith University , Gold Coast, QLD , Australia
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28
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Improving immunity to Haemophilus influenzae in children with chronic suppurative lung disease. Vaccine 2015; 33:321-6. [DOI: 10.1016/j.vaccine.2014.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022]
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29
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Chang AB, Brown N, Toombs M, Marsh RL, Redding GJ. Lung disease in indigenous children. Paediatr Respir Rev 2014; 15:325-32. [PMID: 24958089 DOI: 10.1016/j.prrv.2014.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/20/2022]
Abstract
Children in indigenous populations have substantially higher respiratory morbidity than non-indigenous children. Indigenous children have more frequent respiratory infections that are, more severe and, associated with long-term sequelae. Post-infectious sequelae such as chronic suppurative lung disease and bronchiectasis are especially prevalent among indigenous groups and have lifelong impact on lung function. Also, although estimates of asthma prevalence among indigenous children are similar to non-indigenous groups the morbidity of asthma is higher in indigenous children. To reduce the morbidity of respiratory illness, best-practice medicine is essential in addition to improving socio-economic factors, (eg household crowding), tobacco smoke exposure, and access to health care and illness prevention programs that likely contribute to these issues. Although each indigenous group may have unique health beliefs and interfaces with modern health care, a culturally sensitive and community-based comprehensive care system of preventive and long term care can improve outcomes for all these conditions. This article focuses on common respiratory conditions encountered by indigenous children living in affluent countries where data is available.
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Affiliation(s)
- A B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia; Queensland Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland Medical Research Institute, Queensland University of Technology, Brisbane, Australia.
| | - N Brown
- National Aboriginal Community Controlled Health Organisation and University of Wollongong, Wollongong, New South Wales, Australia
| | - M Toombs
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia; Indigenous Health, Toowoomba Rural Clinical School, University of Queensland
| | - R L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - G J Redding
- University of Washington School of Medicine, Pediatric Pulmonary Division, Children's Hospital and Regional Medical Center, Seattle, Washington, USA
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Torzillo PJ, Chang AB. Acute respiratory infections among Indigenous children. Med J Aust 2014; 200:559-60. [DOI: 10.5694/mja14.00649] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Torzillo
- Department of Respiratory Medicine and Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, NSW
- Nganampa Health Council, Alice Springs, NT
| | - Anne B Chang
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD
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Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Does failed chronic wet cough response to antibiotics predict bronchiectasis? Arch Dis Child 2014; 99:522-5. [PMID: 24521788 DOI: 10.1136/archdischild-2013-304793] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis. METHODS All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression. RESULTS Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10-199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5). CONCLUSIONS Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.
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Affiliation(s)
- Vikas Goyal
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Infectious Diseases, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Julie Marchant
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - I Brent Masters
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Queensland, Australia
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Santiago-Burruchaga M, Zalacain-Jorge R, Vazquez-Cordero C. Are airways structural abnormalities more frequent in children with recurrent lower respiratory tract infections? Respir Med 2014; 108:800-5. [PMID: 24709380 DOI: 10.1016/j.rmed.2014.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED We report bronchoscopic changes observed in children with recurrent lower airways infections (RLAI) and findings in control children undergoing bronchoscopy for causes other than RLAI. PATIENTS AND METHODS Retrospective case-control cohorts study. The clinical records of children who had fiberoptic bronchoscopy (FB) for a history of RLAI without any known underlying disorder between 2007 and 2013 and of control children who required FB for other causes were reviewed. Clinical features, bronchospic findings and bronchoalveolar lavage (BAL) results were assessed. RESULTS Cases were 62 (32 female) children aged 5 years (1-12) and controls 29 children aged 4.5 years (0.5-14). Airway malacia was observed in 32 (52%) vs. 4 (13%) (p = 0.001), profuse respiratory secretions in 34(55%) vs. 6 (20%) (p = 0.007). Endobronchial obstruction: 4 (6.4%) and tracheobronchomegaly were observed only in cases. In cases with profuse respiratory secretions there was a higher prevalence of airways malacia: 64.7% vs. 35.7% (p = 0.04) and of positive BAL cultures: 45.5% vs. 13.3% (p = 0.04). Isolated organisms in cases were non-typable Haemophilus influenzae and Streptococcus pneumoniae most frequently. Pneumocystiis jirovecii, Staphylococcus aureus, and Streptococcus mitis were isolated in controls. CONCLUSIONS Half of the children with RLAI had tracheo and/or bronchomalacia, their frequency being in keeping with previous reports and far higher than that observed in controls. It was associated with profuse respiratory secretions and with a higher frequency of positive BAL cultures mostly for non typable H. influenzae and S. pneumoniae which were not isolated in controls.
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Chang AB, Ooi MH, Perera D, Grimwood K. Improving the Diagnosis, Management, and Outcomes of Children with Pneumonia: Where are the Gaps? Front Pediatr 2013; 1:29. [PMID: 24400275 PMCID: PMC3864194 DOI: 10.3389/fped.2013.00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 10/06/2013] [Indexed: 11/13/2022] Open
Abstract
Pneumonia is the greatest contributor to childhood mortality and morbidity in resource-poor regions, while in high-income countries it is one of the most common reasons for clinic attendance and hospitalization in this age group. Furthermore, pneumonia in children increases the risk of developing chronic pulmonary disorders in later adult life. While substantial advances in managing childhood pneumonia have been made, many issues remain, some of which are highlighted in this perspective. Multiple studies are required as many factors that influence outcomes, such as etiology, patient characteristics, and prevention strategies can vary between and within countries and regions. Also, outside of vaccine studies, most randomized controlled trials (RCTs) on pneumonia have been based in resource-poor countries where the primary aim is usually prevention of mortality. Few RCTs have focused on medium to long-term outcomes or prevention. We propose different tiers of primary outcomes, where in resource-rich countries medium to long-term sequelae should also be included and not just the length of hospitalization and readmission rates.
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Affiliation(s)
- Anne B Chang
- Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia ; Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Mong H Ooi
- Department of Pediatrics, Kuching Hospital , Sarawak , Malaysia
| | - David Perera
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak , Kota Samarahan , Malaysia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, The University of Queensland , Brisbane, QLD , Australia ; Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital , Brisbane, QLD , Australia
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Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): a multicentre, double-blind, randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2013; 1:610-620. [DOI: 10.1016/s2213-2600(13)70185-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Cough may be the first overt sign of disease of the airways or lungs when it represents more than a defense mechanism, and may by its persistence become a helpful pointer of potential disease for both patient and physician. On the other hand, impairment or absence of the coughing mechanism can be harmful and even fatal; this is why cough suppression is rarely indicated in childhood. Pediatricians are concerned more with the etiology of the cough and making the right diagnosis. Whereas chronic cough in adults has been universally defined as a cough that lasts more than 8 weeks, in childhood, different timing has been reported. Many reasons support defining a cough that lasts more than 4 weeks in preschool children as chronic, however; and this is particularly true when the cough is wet. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. In addition, immunological response undergoes developmental and memorial processes that make infection and congenital abnormalities the overwhelming causes of cough in preschool children. Cough in children should be treated on the basis of etiology, and there is no evidence in support of the use of medication for symptomatic cough relief or adopting empirical approaches. Most cases of chronic cough in preschool age are caused by protracted bacterial bronchitis, tracheobronchomalacia, foreign body aspiration, post-infectious cough or some combination of these. Other causes of chronic cough, such as bronchiectasis, asthma, gastroesophageal reflux, and upper respiratory syndrome appear to be less frequent in this age group. The prevalence of each depends on the population in consideration, the epidemiology of infectious diseases, socioeconomic aspects, and the local health system.
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Affiliation(s)
- Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, Bergamo, Italy.
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Montella S, Mollica C, Finocchi A, Pession A, Pietrogrande MC, Trizzino A, Ranucci G, Maglione M, Giardino G, Salvatore M, Santamaria F, Pignata C. Non invasive assessment of lung disease in ataxia telangiectasia by high-field magnetic resonance imaging. J Clin Immunol 2013; 33:1185-91. [PMID: 23975689 DOI: 10.1007/s10875-013-9933-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/08/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE A sensitive imaging technique that assesses ataxia telangiectasia (AT) lung disease without ionizing radiation is highly desirable. We designed a study to evaluate lung changes using magnetic resonance imaging (MRI), and to investigate the relationships among severity and extent of pulmonary abnormalities and clinical, microbiological and functional data in children and young adults with AT. METHODS Fifteen AT patients (age, 11.3 years; range, 6-31) underwent 3.0-T MRI, spirometry, and deep throat or sputum culture. Images were scored using a modified Helbich score. RESULTS Although only 8 patients (53 %) had recurrent/chronic respiratory symptoms, MRI identified lung abnormalities in all. Bronchiectasis, peribronchial thickening, mucous plugging, and collapse/consolidation were present in 60 %, 87 %, 67 %, and 13 % of cases, respectively, with no difference between subjects with or without respiratory symptoms. No difference in changes of specific scores was found between the two groups, but the total MRI score was higher in patients with respiratory symptoms (6.5 versus 5, respectively; p = 0.02). Total or specific MRI scores were not associated with patients' age. Of all scores, only mucous plugging subscore appeared significantly related to FEV1 (r = 0.7, p = 0.04) and FEF25-75% (r = 0.9, p = 0.001). MRI scores from patients with positive (n = 5) or negative (n = 10) sputum culture were not significantly different. CONCLUSIONS MRI is valuable in the assessment of extent and severity of pulmonary changes in children and adults with AT. It represents an helpful tool for the longitudinal evaluation of patients and may be also used as an outcome surrogate to track the effects of medications.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131, Naples, Italy
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Chang AB, Grimwood K, Wilson AC, van Asperen PP, Byrnes CA, O’Grady KAF, Sloots TP, Robertson CF, Torzillo PJ, McCallum GB, Masters IB, Buntain HM, Mackay IM, Ungerer J, Tuppin J, Morris PS. Bronchiectasis exacerbation study on azithromycin and amoxycillin-clavulanate for respiratory exacerbations in children (BEST-2): study protocol for a randomized controlled trial. Trials 2013; 14:53. [PMID: 23421781 PMCID: PMC3586343 DOI: 10.1186/1745-6215-14-53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/22/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bronchiectasis unrelated to cystic fibrosis (CF) is being increasingly recognized in children and adults globally, both in resource-poor and in affluent countries. However, high-quality evidence to inform management is scarce. Oral amoxycillin-clavulanate is often the first antibiotic chosen for non-severe respiratory exacerbations, because of the antibiotic-susceptibility patterns detected in the respiratory pathogens commonly associated with bronchiectasis. Azithromycin has a prolonged half-life, and with its unique anti-bacterial, immunomodulatory, and anti-inflammatory properties, presents an attractive alternative. Our proposed study will test the hypothesis that oral azithromycin is non-inferior (within a 20% margin) to amoxycillin-clavulanate at achieving resolution of non-severe respiratory exacerbations by day 21 of treatment in children with non-CF bronchiectasis. METHODS This will be a multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel group trial involving six Australian and New Zealand centers. In total, 170 eligible children will be stratified by site and bronchiectasis etiology, and randomized (allocation concealed) to receive: 1) azithromycin (5 mg/kg daily) with placebo amoxycillin-clavulanate or 2) amoxycillin-clavulanate (22.5 mg/kg twice daily) with placebo azithromycin for 21 days as treatment for non-severe respiratory exacerbations. Clinical data and a parent-proxy cough-specific quality of life (PC-QOL) score will be obtained at baseline, at the start and resolution of exacerbations, and on day 21. In most children, blood and deep-nasal swabs will also be collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 21. The main secondary outcome is the PC-QOL score. Other outcomes are: time to next exacerbation; requirement for hospitalization; duration of exacerbation, and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood inflammatory markers will be reported where available. DISCUSSION Currently, there are no published randomized controlled trials (RCT) to underpin effective, evidence-based management of acute respiratory exacerbations in children with non-CF bronchiectasis. To help address this information gap, we are conducting two RCTs. The first (bronchiectasis exacerbation study; BEST-1) evaluates the efficacy of azithromycin and amoxycillin-clavulanate compared with placebo, and the second RCT (BEST-2), described here, is designed to determine if azithromycin is non-inferior to amoxycillin-clavulanate in achieving symptom resolution by day 21 of treatment in children with acute respiratory exacerbations. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR) number http://ACTRN12612000010897. http://www.anzctr.org.au/trial_view.aspx?id=347879.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
| | - Keith Grimwood
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Andrew C Wilson
- Department of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia
| | - Peter P van Asperen
- Department of Respiratory Medicine, The Children’s Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland and Starship Children’s Hospital, Auckland, New Zealand
| | | | - Theo P Sloots
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Colin F Robertson
- Department of Respiratory Medicine, Royal Children’s Hospital, Murdoch Children’s Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | | | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ian B Masters
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
| | - Helen M Buntain
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
| | - Ian M Mackay
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Jacobus Ungerer
- Department Chemical Pathology, Queensland Pathology, Royal Brisbane Hospital, Brisbane, Australia
| | - Joanne Tuppin
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
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Chang AB. Specialty grand challenge - pediatric pulmonology. Front Pediatr 2013; 1:14. [PMID: 24400260 PMCID: PMC3860980 DOI: 10.3389/fped.2013.00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Anne B Chang
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Queensland Children's Medical Research Institute, Queensland University of Technology Brisbane, QLD, Australia ; Child Health Division, Menzies School of Health Research Darwin, NT, Australia
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Montella S, Maglione M, Giardino G, Di Giorgio A, Palamaro L, Mirra V, Ursini MV, Salerno M, Pignata C, Caffarelli C, Santamaria F. Hyper IgM syndrome presenting as chronic suppurative lung disease. Ital J Pediatr 2012; 38:45. [PMID: 22992442 PMCID: PMC3484017 DOI: 10.1186/1824-7288-38-45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/14/2012] [Indexed: 12/11/2022] Open
Abstract
The Hyper-immunoglobulin M syndromes (HIGM) are a heterogeneous group of genetic disorders resulting in defects of immunoglobulin class switch recombination. Affected patients show humoral immunodeficiency and high susceptibility to opportunistic infections. Elevated serum IgM levels are the hallmark of the disease, even though in few rare cases they may be in the normal range. Hyper IgM is associated with low to undetectable levels of serum IgG, IgA, and IgE. In some cases, alterations in different genes may be identified. Mutations in five genes have so far been associated to the disease, which can be inherited with an X-linked (CD40 ligand, and nuclear factor-kB essential modulator defects) or an autosomal recessive (CD40, activation-induced cytidine deaminase, and uracil-DNA glycosylase mutation) pattern. The patient herein described presented with recurrent upper and lower respiratory infections and evidence of suppurative lung disease at the conventional chest imaging. The presence of low serum IgG and IgA levels, elevated IgM levels, and a marked reduction of in vivo switched memory B cells led to a clinical and functional diagnosis of HIGM although the genetic cause was not identified.
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Affiliation(s)
- Silvia Montella
- Department of Pediatrics, Federico II University, via Pansini 5, Naples, 80131, Italy
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Chang AB, Grimwood K, Robertson CF, Wilson AC, van Asperen PP, O’Grady KAF, Sloots TP, Torzillo PJ, Bailey EJ, McCallum GB, Masters IB, Byrnes CA, Chatfield MD, Buntain HM, Mackay IM, Morris PS. Antibiotics for bronchiectasis exacerbations in children: rationale and study protocol for a randomised placebo-controlled trial. Trials 2012; 13:156. [PMID: 22937736 PMCID: PMC3488323 DOI: 10.1186/1745-6215-13-156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 08/16/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite bronchiectasis being increasingly recognised as an important cause of chronic respiratory morbidity in both indigenous and non-indigenous settings globally, high quality evidence to inform management is scarce. It is assumed that antibiotics are efficacious for all bronchiectasis exacerbations, but not all practitioners agree. Inadequately treated exacerbations may risk lung function deterioration. Our study tests the hypothesis that both oral azithromycin and amoxicillin-clavulanic acid are superior to placebo at improving resolution rates of respiratory exacerbations by day 14 in children with bronchiectasis unrelated to cystic fibrosis. METHODS We are conducting a bronchiectasis exacerbation study (BEST), which is a multicentre, randomised, double-blind, double-dummy, placebo-controlled, parallel group trial, in five centres (Brisbane, Perth, Darwin, Melbourne, Auckland). In the component of BEST presented here, 189 children fulfilling inclusion criteria are randomised (allocation-concealed) to receive amoxicillin-clavulanic acid (22.5 mg/kg twice daily) with placebo-azithromycin; azithromycin (5 mg/kg daily) with placebo-amoxicillin-clavulanic acid; or placebo-azithromycin with placebo-amoxicillin-clavulanic acid for 14 days. Clinical data and a paediatric cough-specific quality of life score are obtained at baseline, at the start and resolution of exacerbations, and at day 14. In most children, blood and deep nasal swabs are also collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 14. The main secondary outcome is the paediatric cough-specific quality of life score. Other outcomes are time to next exacerbation; requirement for hospitalisation; duration of exacerbation; and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood markers will also be reported. DISCUSSION Effective, evidence-based management of exacerbations in people with bronchiectasis is clinically important. Yet, there are few randomised controlled trials (RCTs) in the neglected area of non-cystic fibrosis bronchiectasis. Indeed, no published RCTs addressing the treatment of bronchiectasis exacerbations in children exist. Our multicentre, double-blind RCT is designed to determine if azithromycin and amoxicillin-clavulanic acid, compared with placebo, improve symptom resolution on day 14 in children with acute respiratory exacerbations. Our planned assessment of the predictors of antibiotic response, the role of antibiotic-resistant respiratory pathogens, and whether early treatment with antibiotics affects duration and time to the next exacerbation, are also all novel. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR) number ACTRN12612000011886.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Keith Grimwood
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Colin F Robertson
- Department of Respiratory Medicine, Royal Children’s Hospital, Murdoch Children’s Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew C Wilson
- Department of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia
| | - Peter P van Asperen
- Department of Respiratory Medicine, The Children’s Hospital at Westmead & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Ann F O’Grady
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Theo P Sloots
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | | | - Emily J Bailey
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ian B Masters
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland and Starship Children’s Hospital, Auckland, New Zealand
| | - Mark D Chatfield
- Research and Education Support Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Helen M Buntain
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Ian M Mackay
- Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Infectious Diseases Laboratory, Royal Children’s Hospital, Brisbane, QLD, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
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Chang AB, Marsh RL, Smith-Vaughan HC, Hoffman LR. Emerging drugs for bronchiectasis. Expert Opin Emerg Drugs 2012; 17:361-78. [DOI: 10.1517/14728214.2012.702755] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Chang AB. Bronchitis. KENDIG & CHERNICKÂS DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2012. [PMCID: PMC7152459 DOI: 10.1016/b978-1-4377-1984-0.00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lambert SB, Ware RS, Cook AL, Maguire FA, Whiley DM, Bialasiewicz S, Mackay IM, Wang D, Sloots TP, Nissen MD, Grimwood K. Observational Research in Childhood Infectious Diseases (ORChID): a dynamic birth cohort study. BMJ Open 2012; 2:bmjopen-2012-002134. [PMID: 23117571 PMCID: PMC3547315 DOI: 10.1136/bmjopen-2012-002134] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Even in developed economies infectious diseases remain the most common cause of illness in early childhood. Our current understanding of the epidemiology of these infections is limited by reliance on data from decades ago performed using low-sensitivity laboratory methods, and recent studies reporting severe, hospital-managed disease. METHODS AND ANALYSIS The Observational Research in Childhood Infectious Diseases (ORChID) study is an ongoing study enrolling a dynamic birth cohort to document the community-based epidemiology of viral respiratory and gastrointestinal infections in early childhood. Women are recruited antenatally, and their healthy newborn is followed for the first 2 years of life. Parents keep a daily symptom diary for the study child, collect a weekly anterior nose swab and dirty nappy swab and complete a burden diary when a child meets pre-defined illness criteria. Specimens will be tested for a wide range of viruses by real-time PCR assays. Primary analyses involves calculating incidence rates for acute respiratory illness (ARI) and acute gastroenteritis (AGE) for the cohort by age and seasonality. Control material from children when they are without symptoms will allow us to determine what proportion of ARIs and AGE can be attributed to specific pathogens. Secondary analyses will assess the incidence and shedding duration of specific respiratory and gastrointestinal pathogens. ETHICS AND DISSEMINATION This study is approved by The Human Research Ethics Committees of the Children's Health Queensland Hospital and Health Service, the Royal Brisbane and Women's Hospital and The University of Queensland. TRIAL REGISTRATION clinicaltrials.gov NCT01304914.
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Affiliation(s)
- Stephen Bernard Lambert
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
- Queensland Health Immunisation Program, Communicable Diseases Branch, Queensland Health, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Population Health and the Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne L Cook
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Frances A Maguire
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
| | - David M Whiley
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Seweryn Bialasiewicz
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
| | - David Wang
- Departments of Molecular Microbiology and Pathology & Immunology, Washington University, School of Medicine, St. Louis, Missouri, USA
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
- Microbiology Division, Pathology Queensland Central Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - Michael D Nissen
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
- Microbiology Division, Pathology Queensland Central Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland and the Royal Children's Hospital, Brisbane, Queensland, Australia
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Feldman C. Bronchiectasis: why the diagnosis shouldn't be missed in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:107-8. [PMID: 21597661 DOI: 10.4104/pcrj.2011.00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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