Abstract
We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.
Highlights
Since first recognized as a distinct diagnostic entity in 2006 [1], protracted bacterial bronchitis (PBB) is internationally recognized as a significant disease in children associated with a considerable illness burden [2]
Our prospective study involving 903 children recruited from the community who presented with ARIwC determined the proportion and characteristics of, and risk factors for, children who subsequently developed PBB diagnosed by pediatric pulmonologists in accordance with cough management guidelines [11,12,13]
Age
Summary
Since first recognized as a distinct diagnostic entity in 2006 [1], protracted bacterial bronchitis (PBB) is internationally recognized as a significant disease in children associated with a considerable illness burden [2]. PBB is characterized by a wet cough that persists for at least 4-weeks in the absence of specific cough pointers and resolves with a 2- or 4-week course of appropriate antibiotics [3]. While PBB-specific knowledge has been growing, much of what is known has been garnered from children referred to specialist pediatric pulmonologists because of chronic cough with scarce community-based data. Identified a need to better understand the natural history of PBB and collect more data on disease burden at the community level [2]. There are no data on the risk factors for the development of PBB in children following an acute respiratory illness
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