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Published on: May 8, 2017

Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations

Nitin Kapur1, Ian Brent Masters, Anne B Chang

  • 1Queensland Children's Respiratory Centre, Royal Children's Hospital, Australia. dr_kapurnitin@rediffmail.com

Respiratory Medicine
|June 9, 2009
PubMed

Insights

Pediatric bronchiectasis exacerbations often present with cough changes. Oral antibiotics fail in 35% of cases, with prophylactic antibiotics increasing this risk.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Research

Background:

  • Children with bronchiectasis experience frequent acute pulmonary exacerbations.
  • Many exacerbations necessitate hospitalization due to treatment failure with oral therapies.
  • Standardized definitions and data on exacerbation features are limited.

Purpose of the Study:

  • To identify clinical and investigational features of exacerbations in pediatric non-cystic fibrosis bronchiectasis.
  • To determine the proportion of exacerbations unresponsive to oral antibiotics.
  • To identify factors associated with oral therapy failure.

Main Methods:

  • Retrospective cohort study of 115 exacerbations in 30 children with non-cystic fibrosis bronchiectasis.
  • Data on clinical features, investigations, and treatments were extracted and analyzed.
  • Diagnosis of bronchiectasis was confirmed by High-Resolution Computed Tomography (HRCT) of the chest.

Main Results:

  • Increased cough frequency (88%) and altered cough character (67%) were most common symptoms.
  • Fever (28%), increased sputum volume (42%), and purulence (35%) were frequent.
  • 35% of exacerbations failed oral antibiotic therapy, requiring hospitalization.
  • Prophylactic antibiotic use was a significant predictor of oral therapy failure (aOR 6.77, p=0.003).

Conclusions:

  • Key clinical features of pediatric non-CF bronchiectasis exacerbations include cough changes and worsening chest signs.
  • A significant proportion of exacerbations do not resolve with oral antibiotics.
  • Prophylactic antibiotic use is associated with an increased risk of oral therapy failure in pediatric bronchiectasis exacerbations.
Abstract

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