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Published on: May 8, 2017
The Respiratory Microbiome in Paediatric Chronic Wet Cough: What Is Known and Future Directions
Brianna Atto1, Yitayal Anteneh2, Seweryn Bialasiewicz3
1School of Health Sciences, University of Tasmania, Launceston, TAS 7248, Australia.
Insights
Chronic wet cough in children, often linked to protracted bacterial bronchitis (PBB) and bronchiectasis, is being better understood through airway microbiome research. New multi-omic studies are paving the way for improved diagnostics and treatments for these serious lung conditions.
Area of Science:
- Pediatric Pulmonology
- Microbiome Research
- Respiratory Medicine
Background:
- Chronic wet cough exceeding 4 weeks signals chronic suppurative lung diseases (CSLD) in children, such as protracted bacterial bronchitis (PBB) and bronchiectasis.
- Early-life lower respiratory infections are key risk factors, potentially leading to persistent infection, inflammation, and irreversible lung damage.
- Traditional culture-based methods for identifying pathogens in pediatric chronic wet cough are being complemented by advanced 'omics technologies.
Purpose of the Study:
- To review the current understanding of the airway microbiome in children experiencing chronic wet cough within the PBB-bronchiectasis continuum.
- To explore emerging concepts from the gut-lung axis and multi-omic studies relevant to disease endotyping.
- To consider how evolving microbiome insights can inform new diagnostic and therapeutic strategies for chronic wet cough.
Main Methods:
- Literature review focusing on pediatric chronic wet cough, protracted bacterial bronchitis, bronchiectasis, and airway microbiome.
- Exploration of multi-omic technologies and their application to respiratory pathobiology.
- Integration of concepts from the gut-lung axis in the context of pediatric lung diseases.
Main Results:
- Advances in 'omics technologies offer a more detailed view of respiratory pathobiology compared to traditional culture-based methods.
- Emerging research highlights the potential influence of the gut-lung axis on airway conditions.
- Understanding the airway microbiome is crucial for developing endotype-based care models for pediatric CSLD.
Conclusions:
- The airway microbiome plays a critical role in the pathogenesis of chronic wet cough in children.
- Multi-omic approaches and gut-lung axis research are essential for advancing the endotyping of PBB and bronchiectasis.
- Evolving microbiome knowledge is driving innovation in the diagnosis and treatment of chronic wet cough in pediatric populations.
Abstract:
Chronic wet cough for longer than 4 weeks is a hallmark of chronic suppurative lung diseases (CSLD), including protracted bacterial bronchitis (PBB), and bronchiectasis in children. Severe lower respiratory infection early in life is a major risk factor of PBB and paediatric bronchiectasis. In these conditions, failure to clear an underlying endobronchial infection is hypothesised to drive ongoing inflammation and progressive tissue damage that culminates in irreversible bronchiectasis. Historically, the microbiology of paediatric chronic wet cough has been defined by culture-based studies focused on the detection and eradication of specific bacterial pathogens. Various 'omics technologies now allow for a more nuanced investigation of respiratory pathobiology and are enabling development of endotype-based models of care. Recent years have seen substantial advances in defining respiratory endotypes among adults with CSLD; however, less is understood about diseases affecting children. In this review, we explore the current understanding of the airway microbiome among children with chronic wet cough related to the PBB-bronchiectasis diagnostic continuum. We explore concepts emerging from the gut-lung axis and multi-omic studies that are expected to influence PBB and bronchiectasis endotyping efforts. We also consider how our evolving understanding of the airway microbiome is translating to new approaches in chronic wet cough diagnostics and treatments.
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