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Paediatric chronic suppurative lung disease: clinical characteristics and outcomes

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Abstract

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.

Conclusion: 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.

What this study adds:

• 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.

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Abbreviations

BAL:

Bronchoalveolar lavage

CF:

Cystic fibrosis

CFU:

Colony-forming unit

CSLD:

Chronic suppurative lung disease

CT:

Computed tomography

IQR:

Interquartile range

PBB:

Protracted bacterial bronchitis

RCT:

Randomised controlled trial

TCC:

Total cell count

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Authors’ contribution

VG contributed to the study design, data collection, data analysis, data interpretation and writing of the manuscript. AC conceptualised the study and contributed to the design, data analysis and review of the manuscript. KG, JM and IBM contributed to the study design and review of the manuscript. VG wrote the first draft of the manuscript. Each author has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

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Authors and Affiliations

  1. Centre for Children’s Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia

    Vikas Goyal, Keith Grimwood, Julie M. Marchant & Anne B. Chang

  2. Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, Brisbane, Queensland, 4101, Australia

    Vikas Goyal, Julie M. Marchant & I. Brent Masters

  3. Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, QLD, 4222, Australia

    Keith Grimwood

  4. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4001, Australia

    Julie M. Marchant & Anne B. Chang

  5. Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, 0811, Australia

    Anne B. Chang

Authors
  1. Vikas Goyal
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  2. Keith Grimwood
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  3. Julie M. Marchant
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  4. I. Brent Masters
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  5. Anne B. Chang
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Corresponding author

Correspondence to Vikas Goyal.

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Financial support

VG is supported by the National Health and Medical Research Council (NHMRC) (1075119) and Children’s Health Foundation Queensland post-graduate scholarships. ABC is supported by NHMRC practitioner fellowship (1058213). This work was supported by NHMRC Centre for Research Excellence for Lung Health in Aboriginal and Torres Strait Islanders grant (1040830). None of the authors received an honorarium, grant or other form of payment to produce the manuscript.

Ethics approval

Children’s Health Queensland Human Research Ethics committee approved the study. This article does not contain any studies with human participants or animals performed by any of the authors; this being a retrospective study, informed consent was not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Communicated by Peter de Winter

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Goyal, V., Grimwood, K., Marchant, J.M. et al. Paediatric chronic suppurative lung disease: clinical characteristics and outcomes. Eur J Pediatr 175, 1077–1084 (2016). https://doi.org/10.1007/s00431-016-2743-5

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  • DOI: https://doi.org/10.1007/s00431-016-2743-5

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