Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

Abstract

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2-4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48-3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72-4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42-13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35-2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26-0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06-0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.Eur J Pediatr. 2018 Feb;177(2):181-192. (PMID: 29285648); Pediatr Pulmonol. 2008 Jun;43(6):519-31. (PMID: 18435475); Pediatr Pulmonol. 2021 Aug;56(8):2707-2716. (PMID: 33939893); Pediatr Pulmonol. 2017 Mar;52(3):293-302. (PMID: 27505297); Chest. 2016 Feb;149(2):508-515. (PMID: 26867834); Pediatr Pulmonol. 2016 Mar;51(3):225-42. (PMID: 26636654); Lancet Child Adolesc Health. 2017 Oct;1(2):83-85. (PMID: 30169208); PLoS One. 2016 Mar 08;11(3):e0150949. (PMID: 26953891); J Paediatr Child Health. 2009 Jan-Feb;45(1-2):42-7. (PMID: 19208065); Pediatrics. 2013 May;131(5):e1576-83. (PMID: 23610200); Ital J Pediatr. 2015 Oct 06;41:73. (PMID: 26444536); Chest. 2012 Oct;142(4):943-950. (PMID: 22459773); Arch Dis Child. 2017 Nov;102(11):1044-1048. (PMID: 28814419); Respirology. 2021 Mar;26(3):241-248. (PMID: 33045125); Chest. 2014 Jun;145(6):1271-1278. (PMID: 24435356); BMC Pediatr. 2013 Aug 15;13:125. (PMID: 23947914); J Paediatr Child Health. 2021 Aug 5;:. (PMID: 34352136); Front Pediatr. 2020 Aug 07;8:433. (PMID: 32850546); Clin Infect Dis. 2009 Jul 1;49(1):124-31. (PMID: 19480579); Chest. 2020 Jul;158(1):303-329. (PMID: 32179109); Eur Respir J. 2017 Aug 24;50(2):. (PMID: 28838975); Arch Dis Child. 2013 Jan;98(1):72-6. (PMID: 23175647); ERJ Open Res. 2020 Oct 05;6(4):. (PMID: 33043055); Am J Respir Crit Care Med. 2005 Jul 15;172(2):195-9. (PMID: 15805178); Chest. 2014 Oct;146(4):1013-1020. (PMID: 24874501); Chest. 2008 Dec;134(6):1122-1128. (PMID: 18689594); J Glob Health. 2013 Jun;3(1):010401. (PMID: 23826505); BMJ Open. 2017 Mar 3;7(3):e013796. (PMID: 28259853); Front Cell Infect Microbiol. 2020 May 14;10:213. (PMID: 32477966); N Engl J Med. 1975 Mar 13;292(11):555-9. (PMID: 1110670); Front Pediatr. 2020 Aug 12;8:444. (PMID: 32903491); Chest. 2008 Aug;134(2):303-309. (PMID: 18641100); Chest. 2017 Sep;152(3):607-617. (PMID: 28645463); Qual Life Res. 2018 Apr;27(4):891-903. (PMID: 29357027); Chest. 2006 Jan;129(1 Suppl):260S-283S. (PMID: 16428719); Front Pediatr. 2020 May 05;8:218. (PMID: 32432064); Med J Aust. 2010 Mar 1;192(5):265-71. (PMID: 20201760); BMC Pediatr. 2015 May 14;15:56. (PMID: 25971445); Chest. 2006 May;129(5):1132-41. (PMID: 16685002); Lancet. 2018 Sep 8;392(10150):866-879. (PMID: 30215382); Pediatr Pulmonol. 2019 Jun;54(6):907-913. (PMID: 31006971); Pediatr Pulmonol. 2017 Mar;52(3):373-381. (PMID: 27458795); Front Pediatr. 2019 Apr 17;7:148. (PMID: 31058123); Lancet Child Adolesc Health. 2019 Dec;3(12):889-898. (PMID: 31635952). Linking ISSN: 20770383. Subset: PubMed not MEDLINE; Grant Information: 1080298, 1045157, 1040830 National Health and Medical Research Council Date of Electronic Publication: 2021 Dec 07. ; Original Imprints: Publication: Basel, Switzerland : MDPI AG, [2012]- <br />