PMID- 27287408 OWN - NLM STAT- MEDLINE DCOM- 20170802 LR - 20181113 IS - 1432-1076 (Electronic) IS - 0340-6199 (Linking) VI - 175 IP - 8 DP - 2016 Aug TI - Paediatric chronic suppurative lung disease: clinical characteristics and outcomes. PG - 1077-84 LID - 10.1007/s00431-016-2743-5 [doi] AB - 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. FAU - Goyal, Vikas AU - Goyal V AUID- ORCID: 0000-0001-7533-2315 AD - Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. drvikasgoyal@gmail.com. AD - Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia. drvikasgoyal@gmail.com. FAU - Grimwood, Keith AU - Grimwood K AD - Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. AD - Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, QLD, 4222, Australia. FAU - Marchant, Julie M AU - Marchant JM AD - Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. AD - Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia. AD - Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4001, Australia. FAU - Masters, I Brent AU - Masters IB AD - Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, 4101, Australia. FAU - Chang, Anne B AU - Chang AB AD - Centre for Children's Health Research, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. AD - Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4001, Australia. AD - Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, 0811, Australia. LA - eng PT - Journal Article DEP - 20160611 PL - Germany TA - Eur J Pediatr JT - European journal of pediatrics JID - 7603873 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Administration, Intravenous MH - Administration, Oral MH - Adolescent MH - Anti-Bacterial Agents/*administration & dosage MH - Bacterial Infections/complications/diagnosis/drug therapy MH - Bronchiectasis/complications/drug therapy MH - Bronchitis/complications/drug therapy MH - Bronchoalveolar Lavage MH - Bronchoscopy MH - Child MH - Child, Preschool MH - Chronic Disease MH - Cough/diagnosis/*drug therapy/etiology MH - Female MH - Hospitalization MH - Humans MH - Infant MH - Lung Diseases/complications/diagnosis/*drug therapy MH - Male MH - Radiography MH - Respiratory Sounds MH - Retrospective Studies MH - Tomography, X-Ray Computed OTO - NOTNLM OT - Airway clearance therapy OT - Antibiotics OT - Children OT - Chronic suppurative lung disease EDAT- 2016/06/12 06:00 MHDA- 2017/08/03 06:00 CRDT- 2016/06/12 06:00 PHST- 2016/03/14 00:00 [received] PHST- 2016/06/07 00:00 [accepted] PHST- 2016/05/26 00:00 [revised] PHST- 2016/06/12 06:00 [entrez] PHST- 2016/06/12 06:00 [pubmed] PHST- 2017/08/03 06:00 [medline] AID - 10.1007/s00431-016-2743-5 [pii] AID - 10.1007/s00431-016-2743-5 [doi] PST - ppublish SO - Eur J Pediatr. 2016 Aug;175(8):1077-84. doi: 10.1007/s00431-016-2743-5. Epub 2016 Jun 11.