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Paediatric chronic suppurative lung disease: clinical characteristics and outcomes
Vikas Goyal1,2, Keith Grimwood3,4, Julie M Marchant3,5,6
1Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. drvikasgoyal@gmail.com.
Insights
Children with persistent wet cough unresponsive to oral antibiotics may have chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy are effective treatments for this condition.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Chronic wet cough in children often requires investigation beyond standard oral antibiotic courses.
- Protracted bacterial bronchitis and bronchiectasis are common considerations for persistent cough.
Purpose of the Study:
- To characterize children with chronic wet cough unresponsive to oral antibiotics.
- To evaluate the efficacy of intravenous antibiotics and airway clearance therapy in this cohort.
Main Methods:
- Retrospective chart review of 22 children hospitalized for persistent wet cough.
- Clinical, bronchoscopic, bronchoalveolar lavage (BAL), and radiographic assessments.
- Analysis of BAL fluid for bacterial growth and inflammatory markers.
Main Results:
- Median cough duration was 26 weeks, with a median of 4 weeks of prior oral antibiotics.
- Bronchoscopy revealed tracheomalacia in 41% and airway neutrophilia in 86%.
- Haemophilus influenzae was grown from BAL fluid in 57% of children.
Conclusions:
- Children with persistent wet cough despite oral antibiotics exhibit BAL characteristics similar to protracted bacterial bronchitis but lack specific radiographic findings.
- Findings suggest chronic suppurative lung disease (CSLD).
- Intravenous antibiotics and airway clearance therapy led to complete cough resolution.
Unlabelled:
We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13-52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4-6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8-14). All were cough-free at follow-up.
Conclusion:
The children's BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent. What is known on this topic? • Chronic wet cough not resolving with appropriate antibiotics increases the likelihood of bronchiectasis. • Children with chronic suppurative lung disease (CSLD) have clinical features of bronchiectasis, but lack the radiographic evidence for this diagnosis.
What This Study Adds:
• Children with CSLD have airway neutrophilia and predominantly Haemophilus influenzae in lower airway cultures, similar to children with protracted bacterial bronchitis and bronchiectasis. • Chronic wet cough in CSLD, unresponsive to oral antibiotics, resolves with intravenous antibiotics and airway clearance therapy.
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