Paediatric chronic suppurative lung disease: clinical characteristics and outcomes.
We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13-52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4-6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8-14). All were cough-free at follow-up.


CONCLUSIONS
The children's BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent. What is known on this topic? • Chronic wet cough not resolving with appropriate antibiotics increases the likelihood of bronchiectasis. • Children with chronic suppurative lung disease (CSLD) have clinical features of bronchiectasis, but lack the radiographic evidence for this diagnosis.


CONCLUSIONS
• Children with CSLD have airway neutrophilia and predominantly Haemophilus influenzae in lower airway cultures, similar to children with protracted bacterial bronchitis and bronchiectasis. • Chronic wet cough in CSLD, unresponsive to oral antibiotics, resolves with intravenous antibiotics and airway clearance therapy.
Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. drvikasgoyal@gmail.com.|Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia. drvikasgoyal@gmail.com.
Vikas
http://orcid.org/0000-0001-7533-2315
V
Goyal
Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.|Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, QLD, 4222, Australia.
Keith
K
Grimwood
Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.|Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia.|Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4001, Australia.
Julie M
JM
Marchant
Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia.
I Brent
IB
Masters
Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.|Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4001, Australia.|Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, 0811, Australia.
Anne B
AB
Chang
D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D001987:Bronchiectasis / Q000150:complications / Q000188:drug therapy; D001991:Bronchitis / Q000150:complications / Q000188:drug therapy; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D011859:Radiography; D012135:Respiratory Sounds; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents
Airway clearance therapy; Antibiotics; Children; Chronic suppurative lung disease