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Long-Term Pulmonary Sequelae 5-14 Years After Protracted Bacterial Bronchitis in Early Childhood
Jan Hermann1,2, Karen Brückner1,3, Cordula Koerner-Rettberg1,4
1Department of Paediatric Pneumology, University Children's Hospital, Ruhr-University, Bochum, Bochum, Germany.
Insights
Protracted bacterial bronchitis (PBB) in childhood can lead to long-term respiratory issues, including persistent cough and reduced lung function. Many children experience ongoing symptoms and potential bronchial wall changes years after the initial infection.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Childhood Infectious Diseases
Background:
- Protracted bacterial bronchitis (PBB) is a primary cause of chronic wet cough in young children.
- Long-term pulmonary sequelae following PBB are not well-documented.
- Understanding these long-term effects is crucial for effective childhood respiratory health management.
Purpose of the Study:
- To investigate long-term pulmonary function and respiratory symptoms in children years after a PBB diagnosis.
- To identify potential structural lung changes associated with prior PBB.
- To assess the predictive value of persistent wet cough for long-term respiratory outcomes.
Main Methods:
- A cohort of 62 children with confirmed PBB underwent follow-up interviews and pulmonary function tests (PFTs) after a median of 7.7 years.
- PFTs included spirometry, body plethysmography, and nitrogen washout.
- Lung imaging (MRI/CT) was offered to children with persistent symptoms.
Main Results:
- 17.7% of children reported chronic or recurring wet cough years post-PBB.
- 24.19% exhibited abnormal spirometry results, with reduced FEV1, FVC, or FEV1/FVC ratios.
- Bronchial wall abnormalities, including early bronchiectasis, were observed in 44% of those who underwent imaging.
Conclusions:
- A significant number of children experience persistent respiratory symptoms and reduced lung function years after PBB.
- Structural bronchial changes can occur even after initial PBB treatment.
- Continuous follow-up is recommended to monitor for and manage late bronchopulmonary complications in these children.
Background:
There is little information about long-term changes in pulmonary function tests (PFTs) many years after protracted bacterial bronchitis (PBB), the most common cause of chronic wet cough in early childhood.
Methods:
Of 200 consecutively recruited children with a previously proven diagnosis of PBB 62 (12.2 years, female 48%) were interviewed after 7.7 (5.4-14.7) years about their previous and current symptoms and pulmonary function tests (PFTs: spirometry, body plethysmography, nitrogen multi-breath washout, exhaled nitric oxide and nasal nitric oxide) were performed. Children with persistent symptoms were offered lung imaging.
Results:
11 (17.7%) patients suffered from chronic or recurring wet cough years after their first PBB episode. 15 (24.19%) had at least one abnormal spirometry parameter. FEV1 was abnormal in eight of 62 (12.9%), LCI 2.5% in seven of 56 (12.5%), FVC in 12 of 62 (19.35%) and FEV1/FVC in five of 62 (8.06%) cases. PFT did not differ between children with and without wet cough. Lung MRI/CT demonstrate in four of nine cases abnormalities of the bronchial walls, including one with incipient bronchiectasis.
Conclusion:
After PBB in early childhood, a significant proportion of children suffer from respiratory symptoms many years later, some have an objectively reduced lung function and structural changes of the bronchial wall despite adequate initial therapy. Wet cough alone seems not to be a sensitive clinical predictor. Due to the retrospective study design, we cannot proof any causal relationship. However, to detect late bronchopulmonary sequelae, continuous follow-up of these children should become mandatory.
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