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Associated Risk Factors and Diagnostic Value of Fiberoptic Bronchoscopy for Protracted Bacterial Bronchitis in
Rong Zhang1, Li Wang1, Chen Gong1
1Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China.
Insights
Protracted bacterial bronchitis (PBB) in children is diagnosed using fiberoptic bronchoscopy (FOB). Allergies to dust mites, milk, and eczema are key risk factors for PBB.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Protracted bacterial bronchitis (PBB) is a chronic wet cough in children that can lead to serious lung conditions.
- Current diagnostic criteria for PBB are nonspecific, increasing the risk of misdiagnosis.
- Early and accurate diagnosis of PBB is crucial to prevent long-term respiratory complications.
Purpose of the Study:
- To evaluate the diagnostic utility of fiberoptic bronchoscopy (FOB) for identifying protracted bacterial bronchitis (PBB) in children.
- To identify significant risk factors associated with the development of PBB.
Main Methods:
- A cohort study involving 347 children with chronic wet cough, divided into suspected PBB (n=141) and non-PBB (n=206) groups.
- Children underwent comprehensive laboratory tests, chest imaging, allergen testing, and suspected PBB cases underwent FOB with bronchoalveolar lavage.
- Lavage and sputum samples were cultured to identify bacterial presence and characteristics.
Main Results:
- Fiberoptic bronchoscopy revealed distinct tracheal changes and specific sputum distribution patterns in children with PBB.
- Significant differences in sputum properties and amounts were observed between PBB and non-PBB groups (P < 0.05).
- Allergies to Dermatophagoides (OR, 2.642), milk protein (OR, 2.452), and eczema (OR, 1.763) were identified as significant risk factors for PBB.
Conclusions:
- Fiberoptic bronchoscopy (FOB) provides valuable diagnostic information for protracted bacterial bronchitis (PBB) by visualizing tracheal wall changes and sputum distribution.
- Specific allergies (Dermatophagoides, milk protein) and eczema are significant risk factors associated with PBB in children.
- FOB findings can aid in distinguishing PBB from other chronic cough conditions, improving diagnostic accuracy.
Objective:
Untreated protracted bacterial bronchitis (PBB), a chronic wet cough prevalent in children, may lead to chronic suppurative lung disease. However, clinical diagnostic criteria are currently nonspecific; thus, PBB may be misdiagnosed. Thus, we assessed the diagnostic value of fiberoptic bronchoscopy (FOB) and the risk factors associated with PBB.
Methods:
Children with chronic cough at The First Affiliated Hospital of Anhui Medical University from January 2015 to May 2020 were enrolled and allocated to a suspected PBB (n = 141) or a non-PBB (n = 206) group. All children underwent extensive laboratory, chest imaging, and allergen tests. Children with suspected PBB underwent FOB with bronchoalveolar lavage; lavage and sputum samples were cultured.
Results:
All 347 children had a chronic wet cough for approximately 2 months. Of 141 children with suspected PBB, 140 received FOB with bronchoalveolar lavage. Visible tracheal changes included pale mucosa, mucosal congestion, edema, swelling, and increased secretions attached to the wall. Sputum was visible primarily in the left main bronchus (78.7%), left lower lobe (59.6%), right upper lobe (62.4%), and right lower lobe (64.5%). Sputum properties and amounts significantly differed between children with vs. without PBB (P < 0.05). Dermatophagoides (odds ratio (OR), 2.642; 95% CI, 1.283-5.369), milk protein (OR, 2.452; 95% CI, 1.243-4.836) allergies, and eczema (OR, 1.763; 95% CI, 1.011-3.075) were risk factors significantly associated with PBB.
Conclusion:
Dermatophagoides, milk protein, and eczema were associated with an increased risk of PBB. Sputum distribution and tracheal wall changes observed through FOB may distinguish PBB and assist in its diagnosis.
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