Long-Term Pulmonary Sequelae 5-14 Years After Protracted Bacterial Bronchitis in Early Childhood

Abstract

Background: There is little information about long-term changes in pulmonary function tests (PFTs) many years after protracted bacterial bronchitis (PBB), the most common cause of chronic wet cough in early childhood.

Methods: Of 200 consecutively recruited children with a previously proven diagnosis of PBB 62 (12.2 years, female 48%) were interviewed after 7.7 (5.4-14.7) years about their previous and current symptoms and pulmonary function tests (PFTs: spirometry, body plethysmography, nitrogen multi-breath washout, exhaled nitric oxide and nasal nitric oxide) were performed. Children with persistent symptoms were offered lung imaging.

Results: 11 (17.7%) patients suffered from chronic or recurring wet cough years after their first PBB episode. 15 (24.19%) had at least one abnormal spirometry parameter. FEV1 was abnormal in eight of 62 (12.9%), LCI 2.5% in seven of 56 (12.5%), FVC in 12 of 62 (19.35%) and FEV1/FVC in five of 62 (8.06%) cases. PFT did not differ between children with and without wet cough. Lung MRI/CT demonstrate in four of nine cases abnormalities of the bronchial walls, including one with incipient bronchiectasis.

Conclusion: After PBB in early childhood, a significant proportion of children suffer from respiratory symptoms many years later, some have an objectively reduced lung function and structural changes of the bronchial wall despite adequate initial therapy. Wet cough alone seems not to be a sensitive clinical predictor. Due to the retrospective study design, we cannot proof any causal relationship. However, to detect late bronchopulmonary sequelae, continuous follow-up of these children should become mandatory.

Keywords: LCI; asthma; bronchiectasis; bronchoscopy; children; chronic wet cough; lung function; nitrogen multiple‐breath washout; pbb.

FIGURE 1

Process‐Flowchart of the study recruitment from the original PBB cohort to the follow‐up cohort. PBB, protracted bacterial bronchitis; PFT, pulmonary function test.