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Original Research: Bronchiectasis |

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

Danielle F. Wurzel, PhD; Julie M. Marchant, PhD; Stephanie T. Yerkovich, PhD; John W. Upham, PhD; Helen L. Petsky, PhD; Heidi Smith-Vaughan, PhD; Brent Masters, PhD; Helen Buntain, PhD; Anne B. Chang, PhD
Author and Funding Information

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.

aQueensland Children’s Medical Research Institute, Brisbane, Australia

bQueensland Children’s Health Service, Brisbane, Australia

cMurdoch Children’s Research Institute, Melbourne, Australia

dQueensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Australia

eSchool of Medicine, The University of Queensland, Brisbane, Australia

fChild Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia

gSchool of Medicine, Griffith University, Gold Coast, Australia

CORRESPONDENCE TO: Danielle Wurzel, PhD, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(5):1101-1108. doi:10.1016/j.chest.2016.06.030
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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.

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