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Frequency of protracted bacterial bronchitis and management pre-respiratory referral
Gloria T Y Lau1, Pamela Laird2,3,4, Paul G Stevenson5
1Department of Respiratory, Perth Children's Hospital, Perth, Western Australia, Australia.
Insights
Protracted bacterial bronchitis (PBB) is the leading cause of chronic cough in children seeking specialist care. Many PBB cases are misdiagnosed and undertreated in primary care, highlighting a need for improved early diagnosis and management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Chronic cough in children is a common reason for referral to tertiary respiratory services.
- Protracted bacterial bronchitis (PBB) is an increasingly recognized cause of persistent cough in pediatric populations.
- Accurate diagnosis and timely management of PBB are crucial to prevent potential long-term respiratory complications.
Purpose of the Study:
- To determine the prevalence of protracted bacterial bronchitis (PBB) among children referred for chronic cough.
- To describe the management strategies employed in primary care for children with chronic cough prior to tertiary referral.
- To identify diagnostic and treatment gaps in the pre-referral management of PBB.
Main Methods:
- A retrospective cohort study was conducted on new patients presenting with cough lasting at least four weeks.
- Data were collected from July 2018 to June 2019 at a single tertiary pediatric outpatient respiratory service.
- Medical records were reviewed for up to 18 months to ascertain diagnoses and management details.
Main Results:
- Protracted bacterial bronchitis (PBB) was the most frequent diagnosis, accounting for 37.9% of referrals for chronic cough.
- The median duration of cough before specialist review was 5.1 months; asthma was the most common initial misdiagnosis (15.9%).
- Most children (78%) still had a cough at their first specialist visit, with only 13.5% having received a 4-week antibiotic course; 34% received asthma treatment.
Conclusions:
- Protracted bacterial bronchitis (PBB) is the predominant cause of chronic cough in children referred to tertiary care.
- PBB is often misdiagnosed and inadequately treated in primary care settings.
- Improved primary care diagnosis and management of PBB are essential for earlier symptom resolution and preventing progression to bronchiectasis.
Aim:
To determine the frequency of protracted bacterial bronchitis (PBB) in children referred to tertiary care with chronic cough and describe management prior to referral.
Methods:
A retrospective cohort study of all new patients with a history of ≥4 weeks of cough seen at the only tertiary paediatric outpatient respiratory service in Western Australia between July 2018 and June 2019. Medical records were reviewed until a final diagnosis was documented or otherwise for a period of 18 months.
Results:
PBB was the most common cause and comprised 37.9% of all children referred to tertiary respiratory care with chronic cough. In children with PBB, the median cough duration at the time of first specialist review was 5.1 months (IQR 2.1-12.0 months). The most common referral source of PBB was primary practice (40.9%) and the most common working diagnosis pre-referral was asthma (15.9%). Seventy-eight percent of children with PBB had an ongoing cough at their first respiratory review, and of these, only 13.5% had been prescribed 4 weeks of antibiotics prior to their respiratory review. Asthma treatment had been prescribed for 34.0% of children with PBB.
Conclusion:
PBB is the most common cause of chronic cough in children referred to tertiary respiratory care and is frequently misdiagnosed and undertreated pre-referral. There is a need to facilitate diagnosis and optimal management of PBB in primary care, which could result in earlier symptom resolution and potentially limit disease progression to bronchiectasis.
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