title: Pediatric bronchiectasis: No longer an orphan disease.
abstract: Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.
authors: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.|Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors: Vikas
authors: V
authors: Goyal
authors: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.|Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, Australia.
authors: Keith
authors: K
authors: Grimwood
authors: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.|Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors: Julie
authors: J
authors: Marchant
authors: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.|Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors: I Brent
authors: IB
authors: Masters
authors: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.|Child Health Division, Menzies School of Health Research, Darwin, Australia.|Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Anne B
authors: AB
authors: Chang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001980:Bronchi / Q000503:physiopathology*; D001987:Bronchiectasis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D003906:Developing Countries; D006801:Humans; D035583:Rare Diseases
chemical_list: D000900:Anti-Bacterial Agents
keywords: children; chronic suppurative lung disease