Original ArticleProtracted Bacterial Bronchitis in Young Children: Association with Airway Malacia
Section snippets
Methods
The diagnostic term chronic purulent bronchitis had customarily been given at our center for children in whom BAL had identified ≥ 104 colony forming units per milliliter (cfu/mL) of specific bacteria judged to be potentially pathogenic as the etiology of symptoms. We therefore first performed a computer search for that diagnostic term during the period from 1999 to 2009 for all patients seen by the Pediatric Allergy & Pulmonary Clinic at the University of Iowa Children’s Hospital.
Results
Seventy patients (20 female, 50 male) met inclusion criteria. All children except 5 had onset of symptoms before the age of 1 year (median, 3 months of age). None of the patients had fever or toxic appearance associated with their respiratory symptoms. The duration of symptoms before being examined by the pediatric allergy and pulmonary physicians at the University of Iowa was at least 1 month, with a range as long as 60 months (median, 5 months). Cough, alone or with other symptoms, was
Discussion
Our findings were consistent with earlier reports that PBB can be a cause of chronic cough in young children. We additionally observed that wheezing and noisy breathing were also associated with PBB. On the basis of our observation of airway malacia in 74% of our patients, we hypothesize that tracheal malacia, bronchial malacia, or both is a predisposing anomaly for PBB. Airway collapse decreases effectiveness of cough and can interfere with normal cephalad mucous flow, an important mechanism
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