Cough Update: Wet cough in children- diagnosis and treatment |
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Cough Update: Wet cough in children- diagnosis and treatment

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Protracted bacterial bronchitis (PBB) is an often encountered etiology of chronic wet cough in preschool children without any symptoms or signs of other specific causes. It can be usually resolved by a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical and the insulting bacteria may be Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.6

PBB is often present with airway malacia in children. The first-line therapy remains Amoxicillin-clavulanate acid for longer than 2 weeks for cough resolution. Even if the wet cough does not improve after prolonged antibiotic treatment, an underlying disease should be considered.6

Protracted bacterial bronchitis (PBB) diagnostic criteria6-

PBB-Clinical

1) Continuous chronic (>4 weeks duration) wet or productive cough2) Absence of symptoms or signs suggestive of other causes of wet or productive cough3) Cough resolved following a 2-week course of an appropriate oral antibiotic treatment

PBB-micro

1) History of chronic wet cough lasting more than 4 weeks2) Positive culture of a respiratory pathogen on BAL (bacterial growth ≥104 CFU/ml in BAL) obtained during a flexible bronchoscopy3) Cough resolved following a 2-week course of an appropriate oral antibiotics (amoxicillin-clavulanate acid)

PBB-extended

PBB-micro or PBB-clinical requiring 4 weeks antibiotic treatment for cough resolution

Recurrent-PBB

Recurrent episodes (>3 per year) of PBB

Characteristic of cough and possible diagnosis6-

Findings associated with cough

Possible diagnosis

Spontaneously resolving cough, good health

Postinfectious cough

Wheezing, dry nocturnal cough, atopy, positive familiarity for asthma/allergy

Asthma

Protracted airway infections, wet cough, positive sputum/BAL culture of a respiratory pathogen

PBB, bronchiectasis

Recurrent lower airways infections, growth failure, chronic sinusitis, hemoptysis, steatorrhea

Cystic fibrosis

Persistent wet cough, digital clubbing, exertional dyspnea, chest wall deformity, auscultatory findings

Chronic Suppurative Lung Disease

Recurrent, severe or atypical Infection

Immunodeficiency (primary or secondary)

Vomiting, sialorrhea, neurodevelopmental disorders

Gastro Esophageal Reflux Disease–foreign body aspiration

Stridor, metallic, or biphasic cough

Airway anomalies (tracheomalacia–bronchomalacia)

Situs inversus, recurrent sinusitis, and/or otitis, recurrent lower airways infections

Primary ciliary dyskinesia

Gallucci M, Pedretti M, Giannetti A, et al. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr. 2020;8:433. Published 2020 Aug 7. doi:10.3389/fped.2020.00433

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