Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis

Wurzel, Danielle F., Marchant, Julie M., Yerkovich, Stephanie T., Upham, John W., Petsky, Helen L., Smith-Vaughan, Heidi, Masters, Brent, Buntain, Helen and Chang, Anne B. (2016) Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis. Chest, 150 5: 1101-1108. doi:10.1016/j.chest.2016.06.030

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Author Wurzel, Danielle F.
Marchant, Julie M.
Yerkovich, Stephanie T.
Upham, John W.
Petsky, Helen L.
Smith-Vaughan, Heidi
Masters, Brent
Buntain, Helen
Chang, Anne B.
Title Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis
Journal name Chest   Check publisher's open access policy
ISSN 1931-3543
Publication date 2016-11-01
Sub-type Article (original research)
DOI 10.1016/j.chest.2016.06.030
Open Access Status File (Author Post-print)
Volume 150
Issue 5
Start page 1101
End page 1108
Total pages 8
Place of publication Glenview, IL, United States
Publisher American College of Chest Physicians
Collection year 2017
Language eng
Formatted abstract
Background: Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of bronchiectasis and (2) identify risk factors for bronchiectasis and recurrent episodes of PBB.

Methods: One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of bronchiectasis.

Results: Of 161 children with PBB (66% boys), 13 were diagnosed with bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) (P =.013) and recurrent episodes of PBB (P =.003). H influenzae infection conferred a more than seven times higher risk of bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P =.009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae. No risk factors for recurrent PBB were identified.

Conclusions: PBB is associated with a future diagnosis of bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.
Keyword Bacterial infection
Pediatric lung disease
Respiratory infection
Viral infection
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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