Pro-con debate

Protracted bacterial bronchitis as a cause of chronic cough in children

Aneela A. Bidiwala, Leonard R. Krilov, Melodi Pirzada, Sameer J. Patel

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterialinfection of conducting airways defined by the presence of cough for longer than 4 weeks that resolves with antimicrobial therapy and without an alternative diagnosis. The diagnosis is made by the findings of increased bronchial secretions and edema of the lower airways on flexible bronchoscopy and positive cultures on bronchoalveolar lavage. It is speculated that an initial respiratory insult such as viral infection disrupts normal surface morphology and ciliary function, which leads to chronic self-perpetuating inflammation with the formation of bacterial biofilms, leading to PBB. PBB is oftenmisdiagnosed as asthma, leading to inappropriate and excessive use of steroids. The importance of timely diagnosis should be emphasizeddue to the potential that PBB may be a precursor to chronic suppurative lung disease or bronchiectasis if left untreated; however,every patient sh ould be adequately assessed to exclude other causes of chronic cough. Con: Clinical criteria for the diagnosis of PBB are nonspecific and may not distinguish it from other known causes of chronic cough,including viral infections. Benefits from antibiotic therapy (particularly prolonged therapy) have not been demonstrated. Respiratory conditions are the most common reason for antibiotic prescriptions during ambulatory visits in the United States, and many of these prescriptions are inappropriate and/or unnecessary. The proposed diagnostic criteria and recommendations for the treatment of PBB will lead to unnecessary overuse of antibiotics.

Original languageEnglish (US)
Pages (from-to)329-336
Number of pages8
JournalPediatric Annals
Volume44
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

Fingerprint

Bronchitis
Cough
Virus Diseases
Anti-Bacterial Agents
Inappropriate Prescribing
Bronchiectasis
Bronchoscopy
Bronchoalveolar Lavage
Biofilms
Complementary Therapies
Lung Diseases
Prescriptions
Edema
Therapeutics
Asthma
Steroids
Inflammation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Pro-con debate : Protracted bacterial bronchitis as a cause of chronic cough in children. / Bidiwala, Aneela A.; Krilov, Leonard R.; Pirzada, Melodi; Patel, Sameer J.

In: Pediatric Annals, Vol. 44, No. 8, 01.08.2015, p. 329-336.

Research output: Contribution to journalArticle

Bidiwala, Aneela A. ; Krilov, Leonard R. ; Pirzada, Melodi ; Patel, Sameer J. / Pro-con debate : Protracted bacterial bronchitis as a cause of chronic cough in children. In: Pediatric Annals. 2015 ; Vol. 44, No. 8. pp. 329-336.
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