Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Abstract

Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterial infection 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 often misdiagnosed as asthma, leading to inappropriate and excessive use of steroids. The importance of timely diagnosis should be emphasized due to the potential that PBB may be a precursor to chronic suppurative lung disease or bronchiectasis if left untreated; however, every patient should 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.

Update on protracted bacterial bronchitis in children

“…PBB with chronic cough and wheezing was likely to misdiagnosis as asthma [13]. These children can be distinguished from asthma which was characterized by a dry cough and effective corticosteroid treatment [4,27]. However, some children with unsatisfactory effects after antibiotic therapy should pay attention to the diagnosis of asthma because some PBB were finally diagnosed as asthma.…”

An underestimated cause of chronic cough: The protracted bacterial bronchitis

“…If PBB fails to respond or becomes recurrent, further investigations such as complete blood count, assessment of immunoglobulins, functional antibody response to vaccination, sweat test, and high-resolution CT are required to rule out other etiologies such as cystic fibrosis, primary ciliary dyskinesia, immunodeficiencies, or dysfunctional swallowing and aspiration issues. [ 40 ] CT scan has an important role, because it has been demonstrated that children with a chronic wet cough failing to resolve after 4 weeks of appropriate oral antibiotics have increased likelihood of developing bronchiectasis. [ 41 ]…”

Kašelj pri otrocih

“…Nekateri strokovnjaki pa opozarjajo, da so diagnostična merila za PBB preveč nespecifična in lahko pripeljejo do prepogoste postavitve diagnoze in zato nepotrebnega dolgotrajnega predpisovanja antibiotikov. To lahko privede do razvoja odpornih sevov (19).…”