Chest
Volume 150, Issue 5, November 2016, Pages 1101-1108
Journal home page for Chest

Original Research: Bronchiectasis
Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis

This work was presented in abstract form at the European Respiratory Society (ERS) International Congress, September 26-30, 2015. Amsterdam, Netherlands.
https://doi.org/10.1016/j.chest.2016.06.030Get rights and content

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.

Section snippets

Study Participants

Participants were enrolled as part of a larger prospective cohort study aimed at evaluating the long-term outcomes of children with chronic cough. Written informed consent was obtained from all parents/guardians, and ethics approval was granted by The Queensland Children’s Health Services Human Research Ethics Committee (HREC/03/QRCH/17).

Between March 2008 and October 2012, 343 children were enrolled. Of them, 161 fulfilled criteria for PBB; 25 were recruited as control participants (15

Clinical and Demographic Characteristics of Participants

Of the 161 children with PBB, 106 completed the 2-year follow-up period and had clinician assessment for bronchiectasis (Fig 1). The median duration of follow-up was 25 months (IQR, 24-28) in children with PBB and 27 months (IQR, 26-29) in control subjects undergoing bronchoscopy.

There was no difference between children who completed the 2-year follow-up and those who did not (Table 1) with regard to duration of cough at recruitment (P = .807), H influenzae status (P = .518), or proportion of

Discussion

This is the first prospective longitudinal cohort study of children with PBB. In our cohort, which was based in a large tertiary pediatric hospital, almost 44% of subjects had recurrent episodes (more than three episodes in the first year after recruitment) and approximately one in 12 were diagnosed with bronchiectasis at 2 years. We identified two significant risk factors for bronchiectasis: recurrent (more than episodes 3 per year) PBB and the presence of H influenzae infection in the lower

Acknowledgments

Author contributions: D. F. W. co-conceptualized the study, is responsible for the content of the manuscript including data analysis and manuscript preparation, and was involved in data collection. J. M. M. co-conceptualized the study and contributed to data interpretation and manuscript preparation. S. T. Y. co-conceptualized the study, contributed to aspects of data analyses, and provided critical review of the manuscript. J. W. U. co-conceptualized the study and provided critical review of

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    FUNDING SUPPORT: This work was supported by the National Health and Medical Research Council (NHMRC) [project grant 1042601 and Centre of Research Excellence grant 1040830] and the Financial Markets Foundation for Children [project grant 2010-005]. D. W. was supported by scholarships from the Thoracic Society of Australia and New Zealand/Allen and Hanbury’s, Queensland Children’s Medical Research Institute and NHMRC [1039688]. A. C. and H. S. V. are supported by NHMRC fellowships [1058213 and 1024175]. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC.

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