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Original Research |

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

Potential conflicts of interest: The authors declare no conflicts of interest in relation to this manuscript.

Funding Sources: 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]. DW 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]. AC and HSV 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. The funders played no role in the conduct of the study or preparation of the manuscript.

Prior abstract presentation: European Respiratory Society (ERS) 2015 International Congress, Amsterdam, Netherlands. Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis. DOI: 10.1183/13993003.congress-2015.OA1994

1Queensland Children’s Medical Research Institute, Brisbane, QLD, Australia

2Queensland Children’s Health Service, Brisbane, QLD, Australia

3Murdoch Children’s Research Institute, Melbourne, VIC, Australia

4Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Australia

5School of Medicine, The University of Queensland, Brisbane, QLD, Australia

6Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia

7School of Medicine, Griffith University, Gold Coast, QLD, Australia

Address correspondence to: Dr Danielle Wurzel MBBS, FRACP, PhD. Murdoch Children’s Research Institute, Melbourne, Victoria 3052, Australia.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.030
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Abstract

Background  Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproven, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to: (a) determine the medium-term risk of bronchiectasis and (b) identify risk factors for bronchiectasis and recurrent episodes of PBB.

Methods  161 children with PBB and 25 controls 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. CT chest was undertaken if clinical features were suggestive of bronchiectasis.

Results  Of 161 children with PBB (66% male), 13 (8.1%) were diagnosed with bronchiectasis over the study period. Almost half (43.5%) with PBB had recurrent episodes (>3/year). Major risk factors for bronchiectasis included: H. influenzae lower airway infection (in BAL) (p=0.013) and recurrent episodes of PBB (p=0.003). H. influenzae infection conferred >7 times higher risk of bronchiectasis [HR 7.55 (95%CI 1.66 - 34.28), p=0.009] compared to absence of H. influenzae. 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. H. influenzae lower airway infection and recurrent PBB are significant predictors. Clinicians should be cognisant of the relationship between PBB and bronchiectasis and appropriate follow-up measures should be taken in those with risk factors.


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