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Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis
Danielle F Wurzel1, Julie M Marchant2, Stephanie T Yerkovich3
1Queensland Children's Medical Research Institute, Brisbane, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Protracted bacterial bronchitis (PBB) can lead to bronchiectasis in some children. Lower airway infection with Haemophilus influenzae and recurrent PBB episodes are key risk factors for this progression.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Medicine
Background:
- Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct pediatric respiratory conditions.
- A potential link between PBB and the development of bronchiectasis in children is hypothesized but unproven.
- This study investigates the medium-term risk and predictors of bronchiectasis following PBB.
Purpose of the Study:
- To determine the risk of developing bronchiectasis in children diagnosed with PBB.
- To identify specific risk factors associated with bronchiectasis development after PBB.
- To identify risk factors for recurrent PBB episodes.
Main Methods:
- A prospective cohort study involving 161 children with PBB and 25 controls.
- A subset of 106 children was followed for two years with flexible bronchoscopy, bronchoalveolar lavage (BAL), and immune function tests.
- Chest CT scans were performed for children with suspected bronchiectasis.
Main Results:
- 8.1% of children with PBB were diagnosed with bronchiectasis during the study period.
- Recurrent PBB episodes (more than 3 per year) affected 43.5% of children.
- Lower airway infection with Haemophilus influenzae (OR 7.55) and recurrent PBB were significant predictors of bronchiectasis.
Conclusions:
- Protracted bacterial bronchitis is associated with an increased risk of future bronchiectasis in a subset of children.
- Haemophilus influenzae lower airway infections and recurrent PBB are significant predictors of bronchiectasis.
- Awareness of the PBB-bronchiectasis relationship is crucial for appropriate clinical management and follow-up.
Background:
Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of bronchiectasis and (2) identify risk factors for bronchiectasis and recurrent episodes of PBB.
Methods:
One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of bronchiectasis.
Results:
Of 161 children with PBB (66% boys), 13 were diagnosed with bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) (P = .013) and recurrent episodes of PBB (P = .003). H influenzae infection conferred a more than seven times higher risk of bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P = .009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae. No risk factors for recurrent PBB were identified.
Conclusions:
PBB is associated with a future diagnosis of bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.
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