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Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis
A B Chang1, G J Redding, M L Everard
1Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. annechang@ausdoctors.net
Abstract:
The role of persistent and recurrent bacterial infection of the conducting airways (endobronchial infection) in the causation of chronic respiratory symptoms, particularly chronic wet cough, has received very little attention over recent decades other than in the context of cystic fibrosis (CF). This is probably related (at least in part) to the (a) reduction in non-CF bronchiectasis in affluent countries and, (b) intense focus on asthma. In addition failure to characterize endobronchial infections has led to under-recognition and lack of research. The following article describes our current perspective of inter-related endobronchial infections causing chronic wet cough; persistent bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. In all three conditions, impaired muco-ciliary clearance seems to be the common risk factor that provides organisms the opportunity to colonize the lower airway. Respiratory infections in early childhood would appear to be the most common initiating event but other conditions (e.g., tracheobronchomalacia, neuromuscular disease) increases the risk of bacterial colonization. Clinically these conditions overlap and the eventual diagnosis is evident only with further investigations and long term follow up. However whether these conditions are different conditions or reflect severity as part of a spectrum is yet to be determined. Also misdiagnosis of asthma is common and the diagnostic process is further complicated by the fact that the co-existence of asthma is not uncommon. The principles of managing PBB, CSLD and bronchiectasis are the same. Further work is required to improve recognition, diagnosis and management of these causes of chronic wet cough in children.
Insights
Persistent and recurrent bacterial endobronchial infections, including persistent bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), are often overlooked causes of chronic wet cough in children. Early childhood infections and impaired muco-ciliary clearance are key risk factors.
Area of Science:
- Pulmonology
- Pediatric Respiratory Medicine
- Infectious Diseases
Background:
- Persistent and recurrent bacterial endobronchial infections are under-recognized causes of chronic wet cough, especially outside of cystic fibrosis (CF).
- Reduced incidence of non-CF bronchiectasis and a focus on asthma have contributed to the lack of attention on these conditions.
- Failure to adequately characterize endobronchial infections has led to under-recognition and limited research.
Purpose of the Study:
- To present a perspective on the inter-related endobronchial infections causing chronic wet cough: persistent bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), and bronchiectasis.
- To highlight impaired muco-ciliary clearance as a common risk factor for lower airway bacterial colonization.
- To discuss the role of early childhood infections and other predisposing conditions in the development of these chronic respiratory conditions.
Main Methods:
- Review of current understanding and clinical perspectives on endobronchial infections leading to chronic wet cough.
- Discussion of common risk factors, including impaired muco-ciliary clearance and early respiratory infections.
- Analysis of clinical overlap, diagnostic challenges, and potential spectrum nature of PBB, CSLD, and bronchiectasis.
Main Results:
- Impaired muco-ciliary clearance is a unifying risk factor enabling bacterial colonization in PBB, CSLD, and bronchiectasis.
- Early childhood respiratory infections are common initiating events, with conditions like tracheobronchomalacia increasing risk.
- Clinical presentation often overlaps, necessitating further investigation and long-term follow-up for definitive diagnosis.
Conclusions:
- PBB, CSLD, and bronchiectasis represent related conditions contributing to chronic wet cough, potentially existing on a spectrum.
- Misdiagnosis of asthma is common, and co-existence of asthma can complicate diagnosis and management.
- Improved recognition, diagnosis, and management strategies for these pediatric chronic wet cough causes are urgently needed.
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