Paediatric chronic suppurative lung disease: clinical characteristics and outcomes

Goyal, Vikas, Grimwood, Keith, Marchant, Julie M., Masters, I. Brent and Chang, Anne B. (2016) Paediatric chronic suppurative lung disease: clinical characteristics and outcomes. European Journal of Pediatrics, 175 8: 1077-1084. doi:10.1007/s00431-016-2743-5


Author Goyal, Vikas
Grimwood, Keith
Marchant, Julie M.
Masters, I. Brent
Chang, Anne B.
Title Paediatric chronic suppurative lung disease: clinical characteristics and outcomes
Journal name European Journal of Pediatrics   Check publisher's open access policy
ISSN 1432-1076
0340-6199
Publication date 2016-08-01
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s00431-016-2743-5
Open Access Status Not Open Access
Volume 175
Issue 8
Start page 1077
End page 1084
Total pages 8
Place of publication Heidelberg, Germany
Publisher Springer
Collection year 2017
Language eng
Formatted abstract
We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13–52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4–6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8–14). All were cough-free at follow-up.

Conclusion: The children’s BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent.What is known on this topic?• Chronic wet cough not resolving with appropriate antibiotics increases the likelihood of bronchiectasis.• Children with chronic suppurative lung disease (CSLD) have clinical features of bronchiectasis, but lack the radiographic evidence for this diagnosis.What this study adds:• Children with CSLD have airway neutrophilia and predominantly Haemophilus influenzae in lower airway cultures, similar to children with protracted bacterial bronchitis and bronchiectasis.• Chronic wet cough in CSLD, unresponsive to oral antibiotics, resolves with intravenous antibiotics and airway clearance therapy.
Keyword Airway clearance therapy
Antibiotics
Children
Chronic suppurative lung disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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