The Important Concept in Children with Chronic Cough: Protracted Bacterial Bronchitis

Abstract

Objective: Chronic cough is a common problem in childhood. In chronic productive cough; there may be important underlying etiological causes such as protracted bacterial bronchitis (PBB), cystic fibrosis, primary ciliary dyskinesia, and immunodeficiencies. PBB is very important especially in terms of causing irreversible bronchiectasis in the long term. In our study, it was aimed to examine the history, clinical, radiological and laboratory findings and evaluation results of the patients over the age of 6 who were diagnosed with PBB in the clinical follow-up.

Materials-Methods: The documents of children over the age of 6 who applied to the pediatric allergy outpatient clinic between January 2021 and June 2022 for more than 4 weeks of productive cough were evaluated retrospectively.

Results: 48 patients aged 6-15.5 years were included in the study. The median age of the patients was 9.2 (6-15.5) years, 62.1% of them were male. The median duration of cough was 7 (4-10) weeks. On physical examination, respiratory sounds were normal in 56.25% of the patients, bilateral crepitant rales in 12 patients, and secretion rales in 9 patients. Considering the radiological findings; Chest X-ray was normal in 60.4% of the patients, peribronchial thickening was present in 35.4%, and chronic changes were present in 4.2%. Thoracic tomography was performed in 16 (33.3%) patients who did not respond to 2-week antibiotic treatment and 56.25% were found to be normal. Sputum culture was obtained in 47.9% of the patients; normal oropharyngeal flora was isolated in 6 patients, Streptococcus pneumonia in 3 patients and Haemophilus influenzae in 2 patients. The sputum culture of the other patients was negative. Antibiotics were given to the patients for 2 weeks in the first stage. In the first control, cough of 32 patients were resolved with treatment. Although the complaints of 8 patients decreased, their productive cough continued, the complaints of the other 8 patients relapsed within 2 weeks. The treatment of the patients was extended to 4 weeks and other etiological factors were re-evaluated. One of the patients was diagnosed with cystic fibrosis, the other was diagnosed with foreign body aspiration when the history was deepened, and pulmonary tuberculosis in 2 patients. IgA level of two patients was <0.1 mg/dl.

Conclusion: Many different underlying diseases can cause chronic productive cough in childhood. When inappropriate drug treatments are administered to the patients, irreversible complications such as bronchiectasis may develop. Protracted bacterial bronchitis, which has been described in recent years, is one of the important causes of chronic productive cough. It is very important to evaluate these patients diagnosed with PBB correctly and to follow up the treatment.