ObjectivesFlexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB.MethodsWe undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013.ResultsThe median (IQR) age at bronchoscopy was 2.9 (1.7–4.4) years and the median (IQR) duration of cough was 11 (8.0–14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients.ConclusionsBacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment.

A single-lobe BAL is insufficient in assessing patients with CF for lower airway infection. Even when BAL specimens are taken from two lobes, a number of infections may be missed.

Depression in the older adult is frequently under-diagnosed and under-treated in the health care setting resulting in increased mortality in the elderly. When the Geriatric Depression Scale (GDS) is administered in combination with other diagnostic evaluations, however, it provides a reliable, valid, and cost-effective depression screening for the elderly. This paper provides psychometric evidence of the efficacy of the GDS, outlines the magnitude of the problems faced among healthcare professionals in assessing depression in the elderly, and encourages the incorporation of the GDS in standard assessment procedures of the older adult.

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