Protracted Bacterial Bronchitis Research Articles

Chronic Bronchitis in Children and Adults: Definitions, Pathophysiology, Prevalence, Risk Factors, and Consequences.

The complex nature of chronic bronchitis (CB) and changing definitions have contributed to challenges in understanding its aetiology and burden. In children, CB is characterised by persistent airway inflammation often linked to bacterial infections and is therefore termed "protracted bacterial bronchitis" (PBB). Longitudinal studies suggest that CB in childhood persists into adulthood in a subgroup. It can also be associated with future chronic respiratory diseases including asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD). Adult CB is traditionally associated with smoking, occupational exposures, and lower socioeconomic status. The interplay between risk factors, childhood CB, adult CB, and other chronic respiratory diseases is intricate, requiring comprehensive longitudinal studies for a clearer understanding of the natural history of CB across the lifespan. Such longitudinal studies have been scarce to date given the logistic challenges of maintaining them over time. In this review, we summarise current evidence on the evolution of the definitions, pathophysiology, risk factors, and consequences of childhood and adulthood chronic bronchitis.

Antibiotics for relapses of protracted bacterial bronchitis

Antibiotics for relapses of protracted bacterial bronchitis

The Respiratory Microbiome in Paediatric Chronic Wet Cough: What Is Known and Future Directions.

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.

Associated Risk Factors and Diagnostic Value of Fiberoptic Bronchoscopy for Protracted Bacterial Bronchitis in Children.

Untreated protracted bacterial bronchitis (PBB), a chronic wet cough prevalent in children, may lead to chronic suppurative lung disease. However, clinical diagnostic criteria are currently nonspecific; thus, PBB may be misdiagnosed. Thus, we assessed the diagnostic value of fiberoptic bronchoscopy (FOB) and the risk factors associated with PBB. Children with chronic cough at The First Affiliated Hospital of Anhui Medical University from January 2015 to May 2020 were enrolled and allocated to a suspected PBB (n = 141) or a non-PBB (n = 206) group. All children underwent extensive laboratory, chest imaging, and allergen tests. Children with suspected PBB underwent FOB with bronchoalveolar lavage; lavage and sputum samples were cultured. All 347 children had a chronic wet cough for approximately 2 months. Of 141 children with suspected PBB, 140 received FOB with bronchoalveolar lavage. Visible tracheal changes included pale mucosa, mucosal congestion, edema, swelling, and increased secretions attached to the wall. Sputum was visible primarily in the left main bronchus (78.7%), left lower lobe (59.6%), right upper lobe (62.4%), and right lower lobe (64.5%). Sputum properties and amounts significantly differed between children with vs. without PBB (P < 0.05). Dermatophagoides (odds ratio (OR), 2.642; 95% CI, 1.283-5.369), milk protein (OR, 2.452; 95% CI, 1.243-4.836) allergies, and eczema (OR, 1.763; 95% CI, 1.011-3.075) were risk factors significantly associated with PBB. Dermatophagoides, milk protein, and eczema were associated with an increased risk of PBB. Sputum distribution and tracheal wall changes observed through FOB may distinguish PBB and assist in its diagnosis.

Pathogenesis of nontypeable Haemophilus influenzae infections in chronic suppurative lung disease.

The respiratory tract antimicrobial defense system is a multilayered defense mechanism that relies upon mucociliary clearance and components of both the innate and adaptive immune systems to protect the lungs from inhaled or aspirated microorganisms. One of these potential pathogens, nontypeable Haemophilus influenzae (NTHi), adopts several, multifaceted redundant strategies to successfully colonize the lower airways and establish a persistent infection. NTHi can impair mucociliary clearance, express multiple multifunctional adhesins for various cell types within the respiratory tract and evade host defenses by surviving within and between cells, forming biofilms, increasing antigenic drift, secreting proteases and antioxidants, and by host-pathogen cross-talk, impair macrophage and neutrophil function. NTHi is recognized as an important pathogen in several chronic lower respiratory disorders, such as protracted bacterial bronchitis, bronchiectasis, cystic fibrosis, and primary ciliary dyskinesia. The persistence of NTHi in human airways, including its capacity to form biofilms, results in chronic infection and inflammation, which can ultimately injure airway wall structures. The complex nature of the molecular pathogenetic mechanisms employed by NTHi is incompletely understood but improved understanding of its pathobiology will be important for developing effective therapies and vaccines, especially given the marked genetic heterogeneity of NTHi and its possession of phase-variable genes. Currently, no vaccine candidates are ready for large phase III clinical trials.

Evaluation of patients with chronic cough in school age children

Introduction: Chronic cough is a common problem in childhood. Simple viral infections can cause chronic cough, as well as underlying progressive diseases. For this reason, guidelines that can be applied in clinical practice are very valuable. In our study, we aimed to evaluate our school-age patients with chronic cough in the light of the literature.&#x0D; Material Method:&#x0D; The files of children over the age of 6 who applied to the pediatric allergy outpatient clinic between January 2022 and June 2022 with cough for more than 4 weeks were evaluated retrospectively.&#x0D; Results:&#x0D; 182 patients aged 6-17.9 years were included in the study. 62.1% of the patients were male, the mean age was 9.8±3.8 years. 32.4% of our patients had asthma; 43.4% Upper airways cough syndrome (20.9% sinusitis, 17.6% allergic rhinitis, 4.9% non-allergic rhinitis); 7.68% Protracted bacterial bronchitis; 6.59% postinfectious cough; 4.9% of our patients had psychogenic cough; 2.2% Gastroesophageal reflux disease; 1.1% patients had brochiectasis; 1.1% of patients had primary ciliary dyskinesia; 0.55% of the patients were diagnosed with eosinophilic esophagitis.&#x0D; Conclusion:&#x0D; Chronic cough in childhood can be caused by many different underlying diseases. It is observed that patients often use drugs such as antibiotics and symptom relievers unnecessarily. Accurate evaluation of patients, especially taking a detailed history, is very important in the management of these cases. It is very valuable to evaluate each patient individually.

ЗАТЯЖНОЙ БАКТЕРИАЛЬНЫЙ БРОНХИТ У ДЕТЕЙ: ЭТИОЛОГИЯ, КЛИНИЧЕСКИЕ ВАРИАНТЫ, РЕНТГЕНОСЕМИОТИКА, КОМОРБИДНОСТЬ

Cough in childhood is one of the most common reasons for and symptoms when contacting a pediatric physician. Chronic (lasting over four weeks) wet/productive cough is of particular diagnostic difficulty when it is caused by protracted bacterial bronchitis (PBB). The purpose of this research was to study the etiology, clinical options, X-ray semiotics and comorbid diseases in children with PBB. Materials and methods used: clinical observation and analysis of case histories of 76 children aged starting 4.5 months up to 16 years old with PBB were carried out from Mar. 2017 to Jun. 2022. Research methods: microbiological, radiography and computed tomography (CT) of the chest, bronchoscopy, allergy diagnostics, spirometry. The design of the study was as follows: multicentre, non-comparative, open-label, non-randomized, ambispective pilot study. Results: PBB is more common in boys (57%) aged 3 to 7 y/o (59%) and is rare in infancy (7%). The majority of patients met the clinical definition of PBB (86%) and responded to 2 weeks of antibiotic therapy with amoxicillin/clavulanate (78%). The microbiological diagnosis of PBB was confirmed in 14% of children based on bronchoscopy with microbiological examination of bronchoalveolar lavage (BAL) fluid or sputum examination. The most common pathogens encountered in BAL, sputum and discharge from the nasopharynx, oropharynx are as follows: S. aureus, M. catarrhalis, H. influenzae and S. pneumoniae. The chest X-ray showed bronchitis changes; the chest CT, which was performed in 10 patients, had showed thickening of the bronchial walls. Bronchial dilatation was found in 3 children, bronchiectasis was found in a single patient. Bronchial asthma was comorbid with PBB, occurred in 22% of PBB cases. Conclusion: it is necessary for a pediatric physician to keep PBB in mind as one of the reasons for chronic wet/productive cough in children in order to correctly and timely diagnose the disease and prescribe its adequate treatment.

Clinical features and pathogen distributions of microbiological-based protracted bacterial bronchitis in children of different ages in Northeast China.

Protracted bacterial bronchitis (PBB) is often diagnosed clinically according to chronic wet cough, which can be resolved by appropriate antibiotics. Though rarely performed in PBB diagnosis, bacterial cultures by sputum or bronchoalveolar lavage (BAL) fluid can provide etiological features, which may be different in western countries and different areas of China. This study aimed to investigate the clinical and etiological features and outcomes in children of different ages with PBB in northeast China. We retrospectively analyzed children diagnosed with PBB by positive BAL fluid or sputum bacterial cultures between 2017 and 2021. Children were divided into three age groups: <1 year (infants), 1-5 years (younger children), and ≥6 years (older children). Clinical characteristics, chest radiographic findings, bronchoscopy findings, microbiological findings, treatment strategies, and outcomes were reviewed and compared among the age groups. Factors associated with remission during follow-up were examined using logistic regression. A total of 45 children with PBB were included, consisting of 24 (53.3%) infants. The infants were often boys and had a shorter cough duration, a lower proportion of expectoration, a greater proportion of wheezing, and less bronchial wall thickening on high-resolution computed tomography compared to older children (P < 0.05). No significant differences were found among the age groups regarding macroscopic findings, except for a higher proportion of tracheobronchial malacia in infants than in older children (P = 0.013). The most commonly cultured bacteria were Haemophilus influenzae (42.2%), followed by Streptococcus pneumoniae (22.2%) and Klebsiella pneumoniae (20.0%). Compared to older children, infants had a higher remission (P = 0.009) and relatively lower relapse rates (P = 0.059). Short duration of cough (OR = 0.58, 95% CI: 0.34-0.99, P = 0.046) and absence of recurrent cephalosporins before diagnosis (OR = 0.05, 95% CI: 0.00-0.73, P = 0.028) were associated with remission. Infants are more prone to PBB, with increased wheezing. Gram-negative bacilli infections are common in infants in northeast China. Older children with PBB should be carefully assessed, treated and followed up, particularly those with long duration of cough and poor response to antibiotic treatments.

Cough and Protracted Bacterial Bronchitis (PBB) in Children Analytic View

The evolution of the concept of PBB is analyzed over time since it appeared as protracted Bronchitis, later protracted bacterial bronchitis (PBB), and finally its "clinical" version, which avoids the need to perform fiberoptic bronchoscopy in children [1-3]. However, this deviates in a significant manner from the principle on which the concept is based, giving rise to the idea of a disease that only affects children with the main characteristic of bacteriological isolation from lower airways. On the other hand, the clinical diagnosis of PBB is made by excluding other diseases through so-called “pointers to specific cough, primarily for chronic cough1” with a posterior reference of signs and symptoms called specific cough pointers[2]. and Finally, in 2020, “Pointers to presence of specific cough” [4]. Comments are then made on how asthma (and early wheezing) and posterior nasal drip syndrome are ruled out as important causes of chronic and recurrent cough in children. In conclusion, the causes of acute and chronic cough in children, with a few exceptions, are quite comparable to the causes of cough in adults. Therefore, an easy and more accurate way of diagnosing cough in children could be to reconsider our concepts of so-called cough pointers, upper airway cough syndrome, and asthma (and early wheezing) in children

ЗАТЯЖНОЙ БАКТЕРИАЛЬНЫЙ БРОНХИТ – ЧАСТАЯ ПРИЧИНА ХРОНИЧЕСКОГО ВЛАЖНОГО КАШЛЯ У ДЕТЕЙ

Based on the bibliographical data, consensus documents, domestic clinical recommendations, the results of the Authors’ own research and their experience in managing of the patients, this lecture represents the information on protracted bacterial bronchitis (PBB) as a common reason for the chronic wet cough in children. The definition and diagnostic criteria of the disease and their improvement during the process of PBB studying are given. The information on epidemiology, etiology and pathogenesis, clinical and laboratory-instrumental diagnostics, differential diagnostics, treatment and consequences of PBB in children is consistently presented as well.

Evaluation of the implementation and clinical effects of an intervention to improve medical follow-up and health outcomes for Aboriginal children hospitalised with chest infections

Aboriginal children hospitalised with acute lower respiratory infections (ALRIs) are at-risk of developing bronchiectasis, which can progress from untreated protracted bacterial bronchitis, often evidenced by a chronic (>4 weeks) wet cough following discharge. We aimed to facilitate follow-up for Aboriginal children hospitalised with ALRIs to provide optimal management and improve their respiratory health outcomes. We implemented an intervention to facilitate medical follow-up four weeks after hospital discharge from a paediatric hospital in Western Australia. The intervention included six-core components that focused on parents, hospital staff and hospital processes. Both health and implementation outcomes were measured for children grouped by three distinct temporal periods of recruitment: (i) nil-intervention, recruited after hospital admission; (ii) health-information only, received during recruitment at hospital admission, pre-intervention; (iii) post-intervention. The primary outcome was the cough-specific quality-of-life score (PC-QoL) in children with a chronic wet cough following discharge. Of the 214 patients that were recruited, 181 completed the study. Follow-up rates one-month post-discharge were higher in the post-intervention (50.7%) than the nil-intervention (13.6%) and health-information (17.1%) groups. PC-QoL in children with a chronic wet cough was also improved in the post-intervention group compared the health information and nil-intervention groups (difference in means between nil-intervention and post-intervention groups=1.83, 95% CI: 0.75, 2.92, p=0.002), aligning with an increase in the percentage who received evidence-based treatment, namely antibiotics at one-month post-discharge (57.9% versus 13.3%). Implementation of our co-designed intervention to facilitate effective and timely medical follow-up for Aboriginal children hospitalised with ALRIs improved their respiratory health outcomes. State, national grants and fellowships.

Evaluation of Patients with Chronic Cough Referred to Pediatric Pulmonology Outpatient Clinic

Objective: A cough that lasts longer than four weeks in children is called chronic cough. The aim of this study is to determine the underlying causes of chronic cough. Material and Methods: Patients aged 0-18 years who were referred to Şanlıurfa Training and Research Hospital pediatric pulmonology outpatient clinic between 27 December 2021 and 30 June 2022 due to chronic cough were enrolled. Patients with known cystic fibrosis, primary ciliary dyskinesia, interstitial lung disease, asthma, bronchopulmonary dysplasia were excluded from the study. The “CHEST Guideline and Expert Panel Report” guideline was used in the approach to chronic cough. Results: 153 patients were included in this study. The most common causes of chronic cough were asthma (30.7%), protracted bacterial bronchitis (20.3%), and upper respiratory tract cough syndrome (11.1%). Wet cough was present in 60.8% of the patients with chronic cough and the most common diagnosis in patients with wet cough were protracted bacterial bronchitis (33.3%), pneumonia and other lung infections (17.2%) and bronchiectasis (12.9%). The most common diagnoses were asthma (68.3%), upper airway cough syndrome (6.7%), and natural recovery (6.7%) in patients with dry cough. Failure to thrive was more common in patients with wet cough than patients with dry cough (p&amp;lt;0.030) and fever, weight loss and desaturation were only present in patients with wet cough. Conclusion: The most common reasons are asthma, protracted bacterial bronchitis and upper airway cough syndrome. The differential diagnosis should be made by pediatricians based on specific cough pointers, careful physical examination and tests performed in line with the recommendations of the guidelines.

Бронхит в детских популяциях различных стран, факторы риска

The issues of etiology, clinical presentation, distribution, diagnosis and treatment of bronchitis, as one of the most common respiratory diseases among children, are of considerable research interest. Risk factors for bronchitis are considered meteorological indicators (wind speed and direction, anomalies in relative humidity and atmospheric pressure, a decrease or increase in temperature), environmental pollution (tobacco smoke, NO2 and PM10), immune dysfunctions, preterm birth, exclusive breastfeeding for ≤ 4 months of life. Currently, a significant place in the research literature is occupied by the issues of acute, protracted bacterial and plastic bronchitis in children. Acute bronchitis is mainly caused by a viral infection, mainly rhinovirus, enterovirus, influenza A and B viruses, parainfluenza, coronavirus, human metapneumovirus and respiratory syncytial virus, with bacteria detected in 1–10% of cases. Protracted bacterial bronchitis, isolated as a clinical diagnosis since 2006, can occur in up to 88,5% of cases in children with chronic wet cough, wheezing and airway deformities, more often in children under 6 years of age and males. Prolonged bacterial bronchitis is mainly caused by the bacteria Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. It is believed that recurrent bronchitis (&gt;3 episodes/year) and the presence of H. influenzae infection in the lower respiratory tract may be significant risk factors for bronchiectasis Plastic bronchitis, a rare disease, in the pediatric population is associated with cardiothoracic surgery (Fontaine operation), infections (viruses influenza, Mycoplasma pneumoniae, tuberculosis, adenoviruses, in particular serotype 7), inflammatory and allergic diseases, acute chest syndrome and iatrogenic processes.

Dijagnostika i terapija hroničnog kašlja

A cough that lasts for more than 8 weeks in adults (those older than 15 years) and more than 4 weeks in children is considered chronic and poses a significant health problem, as it can lead to feelings of fatigue, sleep disturbances, hoarseness, disruption of daily activities, vomiting, and often in women, even incontinence. The differential diagnosis of chronic cough in adults and children has its specificities. In certain cases, the etiological factor remains unknown when referring to unexplained (idiopathic) chronic cough. This paper presents the results of a systematic review of publications in medical databases (PubMed) and guidelines from the European Respiratory Society (ERS) and the American College of Chest Physicians (CHEST), related to the diagnosis and treatment of chronic cough. Diagnostic investigations should be focused on the most common causes of chronic cough. In adults, these include asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung malignancy, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and upper airway cough syndrome. In children, the most common causes of chronic cough are asthma, protracted bacterial bronchitis, cystic fibrosis, primary ciliary dyskinesia, bronchiectasis, tracheobronchomalacia, pertussis, habitual (psychogenic) cough, and foreign body aspiration. The treatment primarily involves excluding medications that might have chronic cough as an adverse effect. Therapy is directed toward treating the underlying cause of chronic cough. If the cough persists despite treatment (refractory cough) or if it's idiopathic, neuromodulatory medications are employed (opioids, gamma-aminobutyric acid analogs, tricyclic antidepressants). Therapeutic options also include breathing and vocal techniques, superior laryngeal nerve blocks, and vocal cord medialization injections. Drugs directly inhibiting sensory receptors (P2X3, TRPV-1, and NK-1 inhibitors) are currently under clinical trial investigation. The use of validated tests is crucial for assessing therapeutic effectiveness. The etiological factors of chronic cough can have both infectious and non-infectious origins and are not always related to lung diseases. Considering that chronic cough is regarded as a condition of hypersensitivity, when causal treatment does not yield satisfactory results or when dealing with idiopathic chronic cough, therapy is directed towards central or peripheral neuromodulation, as well as techniques involving breathing and vocal production.

肺炎链球菌相关性迁延性细菌性支气管炎的研究现状

肺炎链球菌相关性迁延性细菌性支气管炎的研究现状

Change in health outcomes for First Nations children with chronic wet cough: rationale and study protocol for a multi-centre implementation science study

BackgroundIn children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians.We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis.MethodsThis study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure.DiscussionWe hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough.Trial registrationAustralian New Zealand Clinical Trials Registry; ACTRN12622000430730, registered 16 March 2022, Retrospectively registered.

Clinical characteristics of protracted bacterial bronchitis in adults

There are few data regarding adult protracted bacterial bronchitis (PBB). This study aimed to delineate the clinical features of PBB and evaluate their potential diagnostic value in adults. We recruited 55 adult patients with PBB and selected randomly 220 patients with non-PBB as control. A diagnosis of PBB was considered if patients had a cough lasting ≥3 weeks, no abnormalities of chest computed tomography, positive bacterial culture in sputum and/or response well to oral moxifloxacin for 1–4 weeks. The clinical manifestations and laboratory investigations were compared between PBB patients and non-PBB patients. Of the 55 patients with PBB, approximately three-fifths (34, 61.8%) were females with a median age of 46.0 years, which were similar to that of patients with non-PBB. We observed a shorter cough duration in PBB than non-PBB (median 3.0 versus 24.0 months, p < 0.001). Compared to non-PBB patients, PBB patients had higher incidences of productive cough, yellow phlegm and a sensation of mucus in the throat (SMIT) (all p < 0.001). Sputum neutrophils and lymphocytes were markedly elevated in PBB patients than non-PBB patients (both p = 0.004). Bacterial pathogens were detected in eight (28.6%) of 28 cases with PBB. The multivariate analyses showed yellow phlegm, productive cough, SMIT, increased sputum lymphocytes (≥2.3%) and cough duration ≤8.5 months with moderate sensitivity (50.9–81.8%) and moderate-high specificity (60.5–94.4%) for determining PBB. In summary, adults with PBB are characterized by productive cough, yellow phlegm, SMIT and neutrophilic airway inflammation. These cough features and increased sputum lymphocytes may be useful to indicate PBB.

Protracted bacterial bronchitis: new aspects of the problem based on сlinical recommendation of the Ministry of Health of Russian Federation

In world pediatric practice, protracted bacterial bronchitis is the leading cause of chronic cough in preschool-age children. However, in Russia this nosology is not often diagnosed, and in real clinical practice children are observed for doubtful and ambiguous diagnoses. In 2021, the Russian Ministry of Health updated the clinical guidelines “Bronchitis” for pediatric age category with inclusion of protracted bacterial bronchitis in the list of bronchitis variants with designation of disease criteria: wet cough lasting at least 4 weeks, auscultatory symptoms of bronchitis in the absence of signs of chronic lung and bronchial pathology, cough relief after 2 weeks of therapy with an antibacterial drug active against H. influenzae, S. pneumoniae, M. catarrhalis. The article presents a review of the literature on protracted bacterial bronchitis in the historical aspect, and also reflects the criteria of the disease, epidemiology, etiology, pathogenesis, clinical presentation, methods of examination. Particular attention is paid to the treatment and debatable scientific and practical issues in the study of protracted bacterial bronchitis in the light of the clinical guidelines of the Ministry of Health of the Russian Federation. It is emphasized that the etiotropic treatment of protracted bacterial bronchitis is antibacterial therapy. The effectiveness of antibiotics for this disease has been proven in systematic reviews. Therapy is prescribed empirically. The first-line drugs of choice is oral amoxicillin/clavulanic acid. Preference is given to drugs in the form of dispersible tablets. The duration of therapy remains a subject of scientific debate. According to the clinical guidelines of the Russian Federation Ministry of Health, the course of treatment should not exceed 2 weeks, in case of ineffectiveness and/or relapse of protracted bacterial bronchitis, the course of antibiotic therapy may be prolonged to 4–6 weeks.

Protocol for CLASSIC PBB: comparison of lower airway sampling strategies in children with protracted bacterial bronchitis

BackgroundProtracted bacterial bronchitis (PBB) is an endobronchial infection and a the most common cause of chronic wet cough in young children. It is treated with antibiotics, which can only be...

Prevalence of chronic respiratory diseases in Aboriginal children: A whole population study.

The burden of bronchiectasis is disproportionately high in Aboriginal adults, with early mortality. Bronchiectasis precursors, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), often commence in early childhood. We previously reported a 10% prevalence of PBB in Aboriginal children aged 0 to 7 years, however there are no data on prevalence of chronic lung diseases in older children. Our study aimed to determine the prevalence of PBB, CSLD, bronchiectasis, and asthma in Aboriginal children living in four communities. A whole-population cross-sectional community co-designed study of Aboriginal children aged <18-years in four remote communities in Western Australia across two-time points, a month apart. Children were assessed by pediatric respiratory clinicians with spirometry undertaken (when possible) between March-September 2021. Children with respiratory symptoms were followed up via medical record audit from either the local medical clinic or via a respiratory specialist clinic through to March 2022 to establish a final diagnosis. We recruited 392 (91.6%) of those in the selected communities; median age = 8.4 years (interquartile range[IQR] 5.1-11.5). Seventy children (17.9%) had a chronic respiratory pathology or abnormal spirometry results. PBB was confirmed in 30 (7.7%), CSLD = 13 (3.3%), bronchiectasis = 5 (1.3%) and asthma = 17 (4.3%). The prevalence of chronic wet cough significantly increased with increasing age. The prevalence of PBB, CSLD and bronchiectasis is high in Aboriginal children and chronic wet cough increases with age. This study highlights the high disease burden in Aboriginal children and the urgent need for strategies to address these conditions.