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Roberts JM, Chang AB, Goyal V, Kapur N, Marchant JM, McPhail SM, Kularatna S. Rasch validation of the short form (8 item) PC-QoL questionnaire and applicability of use as a health state classification system for a new preference-based measure. Qual Life Res 2024:10.1007/s11136-024-03652-w. [PMID: 38653898 DOI: 10.1007/s11136-024-03652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The parent-proxy paediatric chronic cough quality of life questionnaire (PC-QoL) is a commonly used measure of spillover quality of life in parents of children with chronic cough. To date, spillover health utility in these parents is not routinely estimated largely due to the lack of a suitable instrument. Their perspective is not included in economic evaluations of interventions for their children. We explored developing a health state classification system based on the PC-QoL for measuring health utility spill over in this population. METHODS This study included PC-QoL 8-item responses of 653 parents participating in a prospective cohort study about paediatric chronic cough. Exploratory factor analysis (EFA) and Rasch analysis were used to examine dimensionality and select potential items and level structure. RESULTS EFA indicated that the PC-QoL had one underlying domain. Rasch analysis indicated threshold disordering in all items which improved when items were collapsed from seven to four levels. Two demonstrated differential item functioning (DIF) by diagnosis or ethnicity and were excluded from the final scale. This scale satisfied Rasch assumptions of local independence and unidimensionality and demonstrated acceptable fit to the Rasch model. It was presented to and modified by an expert panel and a consumer panel. The resulting classification system had six items, each with four levels. DISCUSSION The PC-QoL can conform to a Rasch model with minor modifications. It may be a good basis for the classification system of a child cough-specific PBM. A valuation study is required to estimate preference weights for each item and to estimate health utility in parents of children with chronic cough.
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Affiliation(s)
- Jack M Roberts
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Australia.
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Vikas Goyal
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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2
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Chung KF. Defining cough phenotypes: chronic productive cough with obstructive lung function trajectory. THE LANCET. RESPIRATORY MEDICINE 2024; 12:91-93. [PMID: 38109917 DOI: 10.1016/s2213-2600(23)00388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK; Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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3
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Chatziparasidis G, Kantar A, Grimwood K. Pathogenesis of nontypeable Haemophilus influenzae infections in chronic suppurative lung disease. Pediatr Pulmonol 2023. [PMID: 37133207 DOI: 10.1002/ppul.26446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/09/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
The respiratory tract antimicrobial defense system is a multilayered defense mechanism that relies upon mucociliary clearance and components of both the innate and adaptive immune systems to protect the lungs from inhaled or aspirated microorganisms. One of these potential pathogens, nontypeable Haemophilus influenzae (NTHi), adopts several, multifaceted redundant strategies to successfully colonize the lower airways and establish a persistent infection. NTHi can impair mucociliary clearance, express multiple multifunctional adhesins for various cell types within the respiratory tract and evade host defenses by surviving within and between cells, forming biofilms, increasing antigenic drift, secreting proteases and antioxidants, and by host-pathogen cross-talk, impair macrophage and neutrophil function. NTHi is recognized as an important pathogen in several chronic lower respiratory disorders, such as protracted bacterial bronchitis, bronchiectasis, cystic fibrosis, and primary ciliary dyskinesia. The persistence of NTHi in human airways, including its capacity to form biofilms, results in chronic infection and inflammation, which can ultimately injure airway wall structures. The complex nature of the molecular pathogenetic mechanisms employed by NTHi is incompletely understood but improved understanding of its pathobiology will be important for developing effective therapies and vaccines, especially given the marked genetic heterogeneity of NTHi and its possession of phase-variable genes. Currently, no vaccine candidates are ready for large phase III clinical trials.
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Affiliation(s)
- Grigorios Chatziparasidis
- Paediatric Respiratory Unit, IASO Hospital, Larissa, Thessaly, Greece
- Faculty of Nursing, Thessaly University, Larissa, Greece
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Instituti Ospedalieri Bergamaschi, Bergamo, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Keith Grimwood
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
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4
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Laird PJ, Walker R, McCallum G, Toombs M, Barwick M, Morris P, Aitken R, Cooper M, Norman R, Patel B, Lau G, Chang AB, Schultz A. Change in health outcomes for First Nations children with chronic wet cough: rationale and study protocol for a multi-centre implementation science study. BMC Pulm Med 2022; 22:492. [PMID: 36581812 PMCID: PMC9798941 DOI: 10.1186/s12890-022-02219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians. We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis. METHODS This study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure. DISCUSSION We hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12622000430730 , registered 16 March 2022, Retrospectively registered.
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Affiliation(s)
- Pamela J. Laird
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Roz Walker
- grid.1012.20000 0004 1936 7910School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Population Health, University of Western Australia, Perth, WA Australia ,grid.1025.60000 0004 0436 6763Ngangk Yira Institute for Change, Murdoch University, Perth Western, Australia
| | - Gabrielle McCallum
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Maree Toombs
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - Melanie Barwick
- grid.42327.300000 0004 0473 9646Hospital for Sick Children, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Morris
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Robyn Aitken
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, SA Australia ,grid.1043.60000 0001 2157 559XCharles Darwin University College of Indigenous Future, Arts & Society, Darwin, NT Australia
| | - Matthew Cooper
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia
| | - Richard Norman
- grid.1032.00000 0004 0375 4078School of Population Health, Curtin University, Perth, WA Australia
| | - Bhavini Patel
- Northern Territory Department of Health, Darwin, NT Australia
| | - Gloria Lau
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia
| | - Anne B. Chang
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.240562.7Department of Respiratory Medicine, Queensland Children’s Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, QLD Australia
| | - André Schultz
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
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Huang L, Lai K, Zhan C, Long L, Yi F, Zhou J, Zhan W, Lu H, Jiang Z, Chen Y, Jiang M, Chen R, Xie J, Luo W. Clinical characteristics of protracted bacterial bronchitis in adults. Heliyon 2022; 9:e12299. [PMID: 36755583 PMCID: PMC9900482 DOI: 10.1016/j.heliyon.2022.e12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/23/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
There are few data regarding adult protracted bacterial bronchitis (PBB). This study aimed to delineate the clinical features of PBB and evaluate their potential diagnostic value in adults. We recruited 55 adult patients with PBB and selected randomly 220 patients with non-PBB as control. A diagnosis of PBB was considered if patients had a cough lasting ≥3 weeks, no abnormalities of chest computed tomography, positive bacterial culture in sputum and/or response well to oral moxifloxacin for 1-4 weeks. The clinical manifestations and laboratory investigations were compared between PBB patients and non-PBB patients. Of the 55 patients with PBB, approximately three-fifths (34, 61.8%) were females with a median age of 46.0 years, which were similar to that of patients with non-PBB. We observed a shorter cough duration in PBB than non-PBB (median 3.0 versus 24.0 months, p < 0.001). Compared to non-PBB patients, PBB patients had higher incidences of productive cough, yellow phlegm and a sensation of mucus in the throat (SMIT) (all p < 0.001). Sputum neutrophils and lymphocytes were markedly elevated in PBB patients than non-PBB patients (both p = 0.004). Bacterial pathogens were detected in eight (28.6%) of 28 cases with PBB. The multivariate analyses showed yellow phlegm, productive cough, SMIT, increased sputum lymphocytes (≥2.3%) and cough duration ≤8.5 months with moderate sensitivity (50.9-81.8%) and moderate-high specificity (60.5-94.4%) for determining PBB. In summary, adults with PBB are characterized by productive cough, yellow phlegm, SMIT and neutrophilic airway inflammation. These cough features and increased sputum lymphocytes may be useful to indicate PBB.
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6
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Gilchrist FJ, Aspey M, Bowler R, Brodlie M, Desai S, Harris C, Hinton E, Kulkarni H, Ogbolosingha A, Sinha I, Solis-Trapala I, Stock J, Carroll WD. Protocol for CLASSIC PBB: comparison of lower airway sampling strategies in children with protracted bacterial bronchitis. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001722. [PMID: 36645788 PMCID: PMC9680323 DOI: 10.1136/bmjpo-2022-001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Protracted bacterial bronchitis (PBB) is an endobronchial infection and a the most common cause of chronic wet cough in young children. It is treated with antibiotics, which can only be targeted if the causative organism is known. As most affected children do not expectorate sputum, lower airway samples can only be obtained by bronchoalveolar lavage (BAL) samples taken during flexible bronchoscopy (FB-BAL). This is invasive and is therefore reserved for children with severe or relapsing cases. Most children with PBB are treated empirically with broad spectrum antibiotics. CLASSIC PBB will compare the pathogen yield from two less invasive strategies with that from FB-BAL to see if they are comparable. METHODS 131 children with PBB from four UK centres referred FB-BAL will be recruited. When attending for FB-BAL, they will have a cough swab and an induced sputum sample obtained. The primary outcome will be the discordance of the pathogen yield from the cough swab and the induced sputum when compared with FB-BAL. Secondary outcomes will be the sensitivity of each sampling strategy, the success rate of the induced sputum in producing a usable sample and the tolerability of each of the three sampling strategies. DISCUSSION If either or both of the two less invasive airway sampling strategies are shown to be a useful alternative to FB-BAL, this will lead to more children with PBB having lower airway samples enabling targeted antibiotic prescribing. It would also reduce the need for FB, which is known to be burdensome for children and their families. TRIAL REGISTRATION NUMBER ISRCTN79883982.
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Affiliation(s)
- Francis J Gilchrist
- Institute of Applied Clinical Science, Keele University, Keele, UK .,Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Mathew Aspey
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Robert Bowler
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Malcolm Brodlie
- Institute of Celular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Seema Desai
- Department of Microbiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Caroline Harris
- Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Emily Hinton
- On Behalf of Patient and Public Involvement and Engagement for CLASSIC PBB, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Hemant Kulkarni
- Sheffield Children's Hosptial, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aviva Ogbolosingha
- Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ian Sinha
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Joanne Stock
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - William D Carroll
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Albadr MAA, Tiun S, Ayob M, AL-Dhief FT. Particle Swarm Optimization-Based Extreme Learning Machine for COVID-19 Detection. Cognit Comput 2022:1-16. [PMID: 36247809 PMCID: PMC9554849 DOI: 10.1007/s12559-022-10063-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 (coronavirus disease 2019) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2. Recently, it has been demonstrated that the voice data of the respiratory system (i.e., speech, sneezing, coughing, and breathing) can be processed via machine learning (ML) algorithms to detect respiratory system diseases, including COVID-19. Consequently, many researchers have applied various ML algorithms to detect COVID-19 by using voice data from the respiratory system. However, most of the recent COVID-19 detection systems have worked on a limited dataset. In other words, the systems utilize cough and breath voices only and ignore the voices of the other respiratory system, such as speech and vowels. In addition, another issue that should be considered in COVID-19 detection systems is the classification accuracy of the algorithm. The particle swarm optimization-extreme learning machine (PSO-ELM) is an ML algorithm that can be considered an accurate and fast algorithm in the process of classification. Therefore, this study proposes a COVID-19 detection system by utilizing the PSO-ELM as a classifier and mel frequency cepstral coefficients (MFCCs) for feature extraction. In this study, respiratory system voice samples were taken from the Corona Hack Respiratory Sound Dataset (CHRSD). The proposed system involves thirteen different scenarios: breath deep, breath shallow, all breath, cough heavy, cough shallow, all cough, count fast, count normal, all count, vowel a, vowel e, vowel o, and all vowels. The experimental results demonstrated that the PSO-ELM was capable of attaining the highest accuracy, reaching 95.83%, 91.67%, 89.13%, 96.43%, 92.86%, 88.89%, 96.15%, 96.43%, 88.46%, 96.15%, 96.15%, 95.83%, and 82.89% for breath deep, breath shallow, all breath, cough heavy, cough shallow, all cough, count fast, count normal, all count, vowel a, vowel e, vowel o, and all vowel scenarios, respectively. The PSO-ELM is an efficient technique for the detection of COVID-19 utilizing voice data from the respiratory system.
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Affiliation(s)
| | - Sabrina Tiun
- CAIT, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| | - Masri Ayob
- CAIT, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| | - Fahad Taha AL-Dhief
- School of Electrical Engineering, Department of Communication Engineering, Universiti Teknologi Malaysia, UTM Johor Bahru, Johor, Malaysia
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8
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Mai K, Chen X, Zhang K, Gu S, Wu X, Gu Z, Wu Z, Huang K, Liu Z, Yang Z, Chen D. A juvenile murine model with chronic lung inflammation induced by repeated intratracheal instillation of lipopolysaccharides: a versatile and replicable model. Transl Pediatr 2022; 11:1292-1300. [PMID: 36072534 PMCID: PMC9442212 DOI: 10.21037/tp-22-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recurrent lower respiratory tract infection or chronic pulmonary infection often occur in children with chronic lung diseases (CLDs). By continuous lung inflammation, recurrent and chronic infection could cause irreversible airway structural and lung function damage, which eventually leads to respiratory failure and death. METHODS In purpose of recapitulating persistent high-intensity lung inflammation caused by recurrent lower respiratory tract infection or chronic infection, we established a juvenile murine model with chronic lung inflammation induced by repeated intratracheal instillations of lipopolysaccharides (LPS) from Pseudomonas aeruginosa once a week for 4 weeks. Four-week-old C57BL/6N mice were divided into 4 groups, including LPS0.5 group (n=15), LPS1.0 group (n=15), Control group (n=15) and Normal group (n=15). Mice in LPS0.5 group and LPS1.0 group were instilled intratracheally with 0.5 mg/kg LPS and 1.0 mg/kg LPS respectively. Mice in control group were instilled intratracheally with LPS-free sterile 0.9% NaCl, whereas normal group received no treatment. The successful chronic lung inflammation murine model was validated via (I) pathological manifestations of chronic inflammatory mononuclear-cell infiltration and lung parenchyma damage; (II) decreased lung function. RESULTS All mice in LPS1.0 group died before the third instillation. No death after instillation was observed in Control and LPS0.5 group. Histological analysis revealed that in LPS0.5 group, 7 days after the third instillation, most bronchus and parabronchial vessels were wrapped by infiltrating monocytes and lymphocyte and alveolar cavities were compressed, which were not observed in control and normal group. Also, ratio of forced expiratory volume in 0.1 second (FEV0.1) and forced vital capacity (FVC) in LPS0.5 group was significantly lower (P<0.0001) than both control group and normal group, suggesting ventilatory dysfunction developed after repeatedly intratracheal instillation once a week for 4 weeks. CONCLUSIONS Intratracheal instillation of 0.5 mg/kg LPS once a week for 4 weeks can cause chronic lung inflammation in young mice.
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Affiliation(s)
- Kailin Mai
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kangkang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shujun Gu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zihao Gu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhongji Wu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kaiyin Huang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenwei Liu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zifeng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dehui Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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9
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McElrea E, Chang AB, Yerkovich S, O'Farrell HE, Marchant JM. Mucolytics for children with chronic suppurative lung disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Esther McElrea
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
| | - Anne B Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Department of Respiratory and Sleep Medicine; Queensland Children's Hospital; Brisbane Australia
- Menzies School of Health Research; Charles Darwin University; Darwin Australia
| | - Stephanie Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Menzies School of Health Research; Charles Darwin University; Darwin Australia
| | - Hannah E O'Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology; Brisbane Australia
- Menzies School of Health Research, Charles Darwin University; Darwin Australia
| | - Julie M Marchant
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation; Queensland University of Technology; Brisbane Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Brisbane Australia
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10
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Maximiliano Gómez R, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortego-Martell JA, Lesslar OJ, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19. World Allergy Organ J 2022; 15:100649. [PMID: 35600836 PMCID: PMC9117692 DOI: 10.1016/j.waojou.2022.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait
| | - Samar A. Idriss
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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11
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Jones T, O’Grady KAF, Goyal V, Masters IB, McCallum G, Drovandi C, Lung T, Baque E, Brookes DSK, Terranova CO, Chang AB, Trost SG. Bronchiectasis - Exercise as Therapy (BREATH): rationale and study protocol for a multi-center randomized controlled trial. Trials 2022; 23:292. [PMID: 35410363 PMCID: PMC8996596 DOI: 10.1186/s13063-022-06256-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Globally, bronchiectasis (BE) unrelated to cystic fibrosis (CF) is recognized as a major cause of respiratory morbidity, mortality, and healthcare utilization. Children with BE regularly experience exacerbations of their condition resulting in frequent hospitalizations and decreased health-related quality of life (HR-QoL). Guidelines for the treatment and management of BE call for regular exercise as a means of improving aerobic fitness and HR-QoL. Moreover, research in adults with BE has shown that exercise can reduce the frequency of exacerbations, a potent predictor of future lung function decline and respiratory morbidity. Yet, to date, the health benefits resulting from therapeutic exercise have not been investigated in children with BE. The BREATH, Bronchiectasis - Exercise as Therapy, trial will test the efficacy of a novel 8-week, play-based therapeutic exercise program to reduce the frequency of acute exacerbations over 12 months in children with BE (aged ≥ 4 and < 13 years). Secondary aims are to determine the cost-effectiveness of the intervention and assess the program’s impact on aerobic fitness, fundamental movement skill (FMS) proficiency, habitual physical activity, HR-QoL, and lung function. Methods This multi-center, observer-blinded, parallel-group (1:1 allocation), randomized controlled trial (RCT) will be conducted at three sites. One hundred and seventy-four children ≥ 4 and < 13 years of age with BE will be randomized to a developmentally appropriate, play-based therapeutic exercise program (eight, 60-min weekly sessions, supplemented by a home-based program) or usual care. After completing the baseline assessments, the number of exacerbations and secondary outcomes will be assessed immediately post-intervention, after 6 months of follow-up, and after 12 months of follow-up. Monthly, parental contact and medical review will document acute respiratory exacerbations and parameters for cost-effectiveness outcomes. Discussion The BREATH trial is the first fully powered RCT to test the effects of a therapeutic exercise on exacerbation frequency, fitness, movement competence, and HR-QoL in children with bronchiectasis. By implementing a developmentally appropriate, play-based exercise program tailored to the individual needs of children with bronchiectasis, the results have the potential for a major paradigm shift in the way in which therapeutic exercise is prescribed and implemented in children with chronic respiratory conditions. The exercise program can be readily translated. It does not require expensive equipment and can be delivered in a variety of settings, including the participant’s home. The program has strong potential for translation to other pediatric patient groups with similar needs for exercise therapy, including those with obesity, childhood cancers, and neurological conditions such as cerebral palsy. Trial registration Australian and New Zealand Clinical Trials Register (ANZCTR) ACTRN12619001008112
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12
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Schultz A, Chang AB, Gill F, Walker R, Barwick M, Munns S, Cooper MN, Norman R, Laird P. Implementation of a strategy to facilitate effective medical follow-up for Australian First Nations children hospitalised with lower respiratory tract infections: study protocol. BMC Pulm Med 2022; 22:92. [PMID: 35300670 PMCID: PMC8929266 DOI: 10.1186/s12890-022-01878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First Nations children hospitalised with acute lower respiratory infections (ALRIs) are at increased risk of future bronchiectasis (up to 15-19%) within 24-months post-hospitalisation. An identified predictive factor is persistent wet cough a month after hospitalisation and this is likely related to protracted bacterial bronchitis which can progress to bronchiectasis, if untreated. Thus, screening for, and optimally managing, persistent wet cough one-month post-hospitalisation potentially prevents bronchiectasis in First Nations' children. Our study aims to improve the post-hospitalisation medical follow-up for First Nations children hospitalised with ALRIs and thus lead to improved respiratory health. We hypothesize that implementation of a strategy, conducted in a culturally secure manner, that is informed by barriers and facilitators identified by both parents and health care providers, will improve medical follow-up and management of First Nations children hospitalized with ALRIs. METHODS Our trial is a multi-centre, pseudo-randomized stepped wedge design where the implementation of the strategy is tailored for each study site through a combined Participatory Action Research and implementation science approach informed by the Consolidated Framework of Implementation Research. Outcome measures will consist of three categories related to (i) health, (ii) economics and (iii) implementation. The primary outcome measure will be Cough-specific Quality of Life (PC-QoL). Outcomes will be measures at each study site/cluster in three different stages i.e., (i) nil-intervention control group, (ii) health information only control group and (iii) post-intervention group. DISCUSSION If our hypothesis is correct, our study findings will translate to improved health outcomes (cough related quality of life) in children who have persistent wet cough a month after hospitalization for an ALRI. Trial registration ACTRN12622000224729, prospectively registered 8 February 2022, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382886&isReview=true .
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Affiliation(s)
- André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
- Department of Paediatrics, School of Medicine, University of WA, Perth, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Darwin, NT, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
- Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, QLD, Australia
| | - Fenella Gill
- Nursing Research, Perth Children's Hospital, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia
- School of Population Health, University of Western Australia, Perth, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Melanie Barwick
- Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Munns
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, WA, Australia
| | - Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.
- Department of Paediatrics, School of Medicine, University of WA, Perth, Australia.
- Department Physiotherapy, Perth Children's Hospital, Perth, WA, Australia.
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13
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Goyal V, Chang AB. Bronchiectasis in Childhood. Clin Chest Med 2022; 43:71-88. [DOI: 10.1016/j.ccm.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Melek Manshouri N. Identifying COVID-19 by using spectral analysis of cough recordings: a distinctive classification study. Cogn Neurodyn 2022; 16:239-253. [PMID: 34341676 PMCID: PMC8320312 DOI: 10.1007/s11571-021-09695-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/04/2021] [Accepted: 07/01/2021] [Indexed: 12/19/2022] Open
Abstract
Sound signals from the respiratory system are largely taken as tokens of human health. Early diagnosis of respiratory tract diseases is of great importance because, if delayed, it exerts irreversible effects on human health. The Coronavirus pandemic, which is deeply shaking the world, has revealed the importance of this diagnosis even more. During the pandemic, it has become the focus of researchers to differentiate symptoms from similar diseases such as influenza. Among these symptoms, the difference in cough sound played a distinctive role in research. Clinical data collected under the supervision of doctors in a reliable environment were used as the dataset consisting of 16 subjects suspected of COVID-19 with a specific patient demographic. Using the polymerase chain reaction test, the suspected subjects were divided into two groups as negative and positive. The negative and positive labels represent the patients with non-COVID and with a COVID-19 cough, respectively. Using the 3D plot or waterfall representation of the signal frequency spectrum, the salient features of the cough data are revealed. In this way, COVID-19 can be differentiated from other coughs by applying effective feature extraction and classification techniques. Power spectral density based on short-time Fourier transform and mel-frequency cepstral coefficients (MFCC) were chosen as the efficient feature extraction method. From among the classification techniques, the support vector machine (SVM) algorithm was applied to the processed signals in order to identify and classify COVID-19 cough. In terms of results evaluation, the cough of subjects with COVID-19 was detected with 95.86% classification accuracy thanks to the radial basis function (RBF) kernel function of SVM and the MFCC method. The diagnosis of COVID-19 coughs was performed with 98.6% and 91.7% sensitivity and specificity, respectively.
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Affiliation(s)
- Negin Melek Manshouri
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Avrasya University, 61080 Trabzon, Turkey
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15
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Ha TAN, Ongkasuwan J, Spielberg DR, Zhu H, Das S. Type-1 Laryngeal Cleft and Pathogenic Bacterial Growth in the Lower Airway in Children. Laryngoscope 2022; 132:1825-1828. [PMID: 35084780 DOI: 10.1002/lary.30023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to evaluate the association between type-1 laryngeal clefts and pathogenic bacterial growth in the lower airway in children. STUDY DESIGN Retrospective chart review. METHODS A retrospective chart review was conducted for all children who underwent direct laryngoscopy, flexible bronchoscopy with bronchoalveolar lavage (BAL), and esophagogastroduodenoscopy, under a single anesthetic event from 2015 until 2018 at an academic tertiary referral center. Type-1 laryngeal clefts were diagnosed as an interarytenoid depth at or below the level of the vocal folds, on direct laryngoscopy, via palpation by a fellowship-trained pediatric otolaryngologist. Pathogenic bacterial growth in the lower airway was defined as presence of BAL culture growth of nonrespiratory flora. RESULTS A total of 217 patients were identified. Type-1 laryngeal cleft was significantly associated with chronic cough (P = .0016) and cough with feeds (P < .0001). However, an abnormal video fluoroscopic swallow study was not found to be significantly associated with type-1 laryngeal cleft (P = .92) or pathogenic bacterial growth in the lower airway (P = 0.19). Overall, 122 (56%) patients were diagnosed with type-1 laryngeal cleft, 75 (35%) had pathogenic bacterial growth in the lower airway and 50 (23%) had both type-1 laryngeal cleft and pathogenic bacterial growth in the lower airway. Type-1 laryngeal cleft was significantly associated with pathogenic bacterial growth in the lower airway on both univariate analysis (P = .0307) and multivariate analysis (P = .0298, odds ratio 1.922, 95% confidence interval 1.066-3.467). CONCLUSION Children with type-1 laryngeal clefts are at higher risk of having pathogenic bacterial growth in the lower airway. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Tu-Anh N Ha
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Julina Ongkasuwan
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - David R Spielberg
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Huirong Zhu
- Outcomes and Impacts Service, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Shailendra Das
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, U.S.A
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16
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Chang AB, Grimwood K, Boyd J, Fortescue R, Powell Z, Kantar A. Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline. Breathe (Sheff) 2022; 17:210105. [PMID: 35035559 PMCID: PMC8753694 DOI: 10.1183/20734735.0105-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022] Open
Abstract
Bronchiectasis, characterised by chronic wet/productive cough with recurrent respiratory exacerbations and abnormal bronchial dilatation on computed tomography scans, remains an increasingly recognised but often neglected chronic pulmonary disorder in children and adolescents. An early diagnosis combined with optimal management offers the prospect, at least in some patients, of curing a condition previously considered irreversible. However, unlike in adults, until now no international paediatric guidelines existed. The recently published European Respiratory Society clinical practice guidelines for the management of children and adolescents with bronchiectasis attempts to address this clinical information gap. The guidelines were formulated by panel members comprised of experts from several relevant health fields, the European Lung Foundation and parents of children with bronchiectasis. Systematic reviews and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach guided the nature and strength of recommendations. The recommendations are grouped into clinically relevant topics: diagnosis, evaluating for underlying causes, defining exacerbations, management, systematic care, monitoring, reversibility and prevention. The guidelines seek to achieve: 1) optimal lung growth, 2) preserved lung function, 3) enhanced quality of life, 4) minimal exacerbations, 5) few or no complications, and 6) if possible, reversal of lung injury for each child/adolescent with bronchiectasis. This review presents example cases that highlight the recommendations of the clinical practice guidelines. An international guideline for managing children/adolescents with bronchiectasis is now availablehttps://bit.ly/3A3XYnN
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Australia
| | | | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Sheffield, UK
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
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17
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Hyun JH, Jeong JE, Kim YH, Jang YY, Chung HL. Clinical characteristics of bronchiolitis obliterans without preceding severe lower respiratory tract infection. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jong Hyo Hyun
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Eun Jeong
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Young Jang
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
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18
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Capizzi A, Salvati P, Gallizia A, Rossi GA, Sacco O. Is secondary tracheomalacia associated with airway inflammation and infection? Pediatr Int 2022; 64:e15034. [PMID: 34674343 DOI: 10.1111/ped.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recurrent lower respiratory tract infections are among the most prevalent symptoms in secondary tracheomalacia due to mediastinal vascular anomalies (MVAs). It is not known whether this condition could result in persistent lower respiratory tract inflammation and subclinical infection. METHODS A retrospective study was performed on records of children with tracheomalacia due to MVAs and recurrent respiratory infections who underwent computed tomography scan, bronchoscopy, and bronchoalveolar lavage (BAL) as part of their clinical evaluation. RESULTS Thirty-one children were included in the study: 21 with aberrant innominate artery, four with right aortic arch, one with double aortic arch, and five with aberrant innominate artery associated with right aortic arch. Cytological evaluation of bronchoalveolar lavage fluid showed increased neutrophil percentages and normal lymphocyte and eosinophil proportions. Microorganism growth was detected in 13 BAL samples, with a bacterial load ≥104 colony-forming units/mL in eight (25.8%) of them. Most isolates were positive for Haemophilus influenzae. Bronchiectasis was detected in four children, all with BAL culture positive for H. influenzae. Four patients underwent MVA surgical correction and 27 conservative management, i.e., respiratory physiotherapy in all and high-dose amoxicillin/clavulanic acid (40 mg/kg/day) for 2-4 weeks in those with significant bacterial growth. There was an excellent outcome in most of them. CONCLUSIONS Neutrophilic alveolitis is detectable in secondary tracheomalacia but is associated with a clinically significant bacterial load only in a quarter of the patients. Caution should be used regarding inappropriate antibiotic prescriptions to avoid the emergence of resistance, whilst airway clearance maneuvers and infection preventive measures should be promoted.
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Affiliation(s)
- Antonino Capizzi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Pietro Salvati
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Annalisa Gallizia
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Giovanni A Rossi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Oliviero Sacco
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
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19
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COVID-19 detection in cough, breath and speech using deep transfer learning and bottleneck features. Comput Biol Med 2021; 141:105153. [PMID: 34954610 PMCID: PMC8679499 DOI: 10.1016/j.compbiomed.2021.105153] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
We present an experimental investigation into the effectiveness of transfer learning and bottleneck feature extraction in detecting COVID-19 from audio recordings of cough, breath and speech. This type of screening is non-contact, does not require specialist medical expertise or laboratory facilities and can be deployed on inexpensive consumer hardware such as a smartphone. We use datasets that contain cough, sneeze, speech and other noises, but do not contain COVID-19 labels, to pre-train three deep neural networks: a CNN, an LSTM and a Resnet50. These pre-trained networks are subsequently either fine-tuned using smaller datasets of coughing with COVID-19 labels in the process of transfer learning, or are used as bottleneck feature extractors. Results show that a Resnet50 classifier trained by this transfer learning process delivers optimal or near-optimal performance across all datasets achieving areas under the receiver operating characteristic (ROC AUC) of 0.98, 0.94 and 0.92 respectively for all three sound classes: coughs, breaths and speech. This indicates that coughs carry the strongest COVID-19 signature, followed by breath and speech. Our results also show that applying transfer learning and extracting bottleneck features using the larger datasets without COVID-19 labels led not only to improved performance, but also to a marked reduction in the standard deviation of the classifier AUCs measured over the outer folds during nested cross-validation, indicating better generalisation. We conclude that deep transfer learning and bottleneck feature extraction can improve COVID-19 cough, breath and speech audio classification, yielding automatic COVID-19 detection with a better and more consistent overall performance.
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20
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Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121161. [PMID: 34943357 PMCID: PMC8700365 DOI: 10.3390/children8121161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Background: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. Methods: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. Results: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae) was significantly higher (p = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65–96%) and 48% (95% CI: 31–66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47–65%) and 80% (95% CI: 60–91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies.
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21
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Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies. J Clin Med 2021; 10:jcm10245735. [PMID: 34945030 PMCID: PMC8707704 DOI: 10.3390/jcm10245735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/26/2023] Open
Abstract
We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.
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22
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Ntesou D, Douros K, Tsiambas E, Maipas S, Sarlanis H, Lazaris AC, Kavantzas N. Impact of Immune-Inflammatory Microenvironment Alterations on the Bronchial Lumen of Children With Protracted Bacterial Bronchitis. Cureus 2021; 13:e20554. [PMID: 35103134 PMCID: PMC8776515 DOI: 10.7759/cureus.20554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Protracted bacterial bronchitis is a syndrome that is among the most common causes of chronic cough. In order to understand its pathogenetic mechanisms, there is an increasing interest in the study of the immune microenvironment in the bronchial lumen. The aim of this retrospective study is the determination of the types and quantity of the inflammatory cells that infiltrate the bronchial epithelium as well as of the thickness of the basement membrane. Ninety-seven endobronchial biopsies, obtained from 77 children (30 males and 47 females) aged between 5 and 14 years, with chronic (>8 weeks) wet/productive cough, were subjected to hematoxylin and eosin staining. Using an appropriate image analysis and processing software, we determined the types and the quantity of the inflammatory cells that infiltrated the bronchial epithelium, and the thickness of the basement membrane. The metric data were then subjected to extensive statistical analysis. According to our results, females had increased levels of eosinophils (p = 0.021) and lymphocytes (p = 0.044) compared to males. Moreover, we found that membrane thickness was negatively correlated with the number of eosinophils (p < 0.0001), neutrophils (p = 0.023), and lymphocytes (p = 0.024). Finally, the pairwise comparisons of the number of eosinophils, neutrophils, lymphocytes, and other cell types revealed significant (p < 0.05) positive correlations. Protracted bacterial bronchitis activates pulmonary innate immune pathways. Also, it is accompanied by basement membrane thickening, which is a typical characteristic of several respiratory diseases, such as asthma.
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Affiliation(s)
- Despoina Ntesou
- Department of Laboratory Medicine, University of West Attica, Egaleo, GRC
| | - Konstantinos Douros
- Third Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Evangelos Tsiambas
- Department of Cytopathology, 417 Army Equity Fund Hospital (NIMTS), Athens, GRC
| | - Sotirios Maipas
- Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Helen Sarlanis
- Pathology, National and Kapodistrian University of Athens, Athens, GRC
| | - Andreas C Lazaris
- Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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23
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Al Shamrani A, AlShammari A, AlAlkami H, AlShanwani J, Alharbi AS. When is asthma not guilty? Int J Pediatr Adolesc Med 2021; 8:203-211. [PMID: 34401444 PMCID: PMC8356124 DOI: 10.1016/j.ijpam.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/12/2020] [Accepted: 10/18/2020] [Indexed: 11/20/2022]
Abstract
Asthma is a common childhood condition. Its prevalence in Saudi Arabia is high, increasing, and could exceed 20% at the current trajectory. Asthma is a syndrome with different clinical presentations and phenotypes. Many conditions are often misdiagnosed as asthma because they share the same symptoms, particularly coughing and shortness of breath; physical findings, such as wheezing; radiological findings, such as hyperinflation on chest X-ray; or even responses to asthma therapies, as in some patients with bronchiolitis. When treating the younger age group (>5 years old), there should be a high degree of suspicion of alternative causes when evaluating patients presenting with clinical features suggestive of asthma or patients who do not respond well to asthma therapies. This study will highlight common conditions that may mimic asthma and, as a result of incorrect treatment, unnecessarily expose patients to steroids and other therapies for extended periods. Furthermore, we seek to alert healthcare providers to common symptoms and signs that suggest a cause other than asthma and suggest when to refer the patient to subspecialists.
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Affiliation(s)
| | - Ayshah AlShammari
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Halima AlAlkami
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Jawaher AlShanwani
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
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24
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The Relationship between Aeroallergen Sensitization and Chronic Cough in School-Aged Children from General Population. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5513611. [PMID: 34840976 PMCID: PMC8616696 DOI: 10.1155/2021/5513611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
Objective Determining sensitivity to allergens is an essential step in diagnosing children with allergic diseases. Chronic cough has remained poorly understood with causative triggers. The purpose of our study was to shed light on the relationship between sensitization to aeroallergens and chronic cough. Methods This population-based study examined children (aged 7 years to 13 years) between June and July 2016. The 1,259 children, 72 of whom (5.7%) had a chronic cough, and 1,187 of whom (94.3%) did not (controls), completed the questionnaire, but 1,051 children completed skin prick tests (SPTs) with eight aeroallergens. Results There were positive SPT results to at least 1 allergen in 549 children (52.2%). Sensitization to house dust mite (HDM) was most common (chronic cough = 46.9%; controls = 47.2%), followed by pollen (chronic cough = 21.9%; controls = 16.5%) in both groups, but there was no difference in allergic profile and sensitization to aeroallergen (P > 0.05 for all comparisons). Multivariable analysis with adjustment for confounding indicated that children who were in sensitization to pollen had an increased risk of chronic cough (aOR = 2.387; 95% CI: 1.115 to 5.111; P = 0.025). Multivariable analysis with adjustment for confounding indicated that children who were exposed to current smoking (aOR = 4.442; 95% CI: 1.831 to 10.776; P = 0.001) and mold (aOR = 1.988; 95% CI: 1.168 to 3.383; P = 0.011) were associated with chronic cough. Conclusion Sensitization to pollen should be considered as a potential contributing factor to the development of chronic cough in school-aged children.
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Pahar M, Klopper M, Reeve B, Warren R, Theron G, Niesler T. Automatic cough classification for tuberculosis screening in a real-world environment. Physiol Meas 2021; 42. [PMID: 34649231 DOI: 10.1088/1361-6579/ac2fb8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022]
Abstract
Objective.The automatic discrimination between the coughing sounds produced by patients with tuberculosis (TB) and those produced by patients with other lung ailments.Approach.We present experiments based on a dataset of 1358 forced cough recordings obtained in a developing-world clinic from 16 patients with confirmed active pulmonary TB and 35 patients suffering from respiratory conditions suggestive of TB but confirmed to be TB negative. Using nested cross-validation, we have trained and evaluated five machine learning classifiers: logistic regression (LR), support vector machines, k-nearest neighbour, multilayer perceptrons and convolutional neural networks.Main Results.Although classification is possible in all cases, the best performance is achieved using LR. In combination with feature selection by sequential forward selection, our best LR system achieves an area under the ROC curve (AUC) of 0.94 using 23 features selected from a set of 78 high-resolution mel-frequency cepstral coefficients. This system achieves a sensitivity of 93% at a specificity of 95% and thus exceeds the 90% sensitivity at 70% specificity specification considered by the World Health Organisation (WHO) as a minimal requirement for a community-based TB triage test.Significance.The automatic classification of cough audio sounds, when applied to symptomatic patients requiring investigation for TB, can meet the WHO triage specifications for the identification of patients who should undergo expensive molecular downstream testing. This makes it a promising and viable means of low cost, easily deployable frontline screening for TB, which can benefit especially developing countries with a heavy TB burden.
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Affiliation(s)
- Madhurananda Pahar
- Department of Electrical and Electronic Engineering, Stellenbosch University, South Africa
| | - Marisa Klopper
- SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, DSI/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Byron Reeve
- SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, DSI/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Rob Warren
- SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, DSI/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Grant Theron
- SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, DSI/NRF Centre of Excellence for Biomedical Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Thomas Niesler
- Department of Electrical and Electronic Engineering, Stellenbosch University, South Africa
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26
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Pahar M, Klopper M, Warren R, Niesler T. COVID-19 cough classification using machine learning and global smartphone recordings. Comput Biol Med 2021; 135:104572. [PMID: 34182331 PMCID: PMC8213969 DOI: 10.1016/j.compbiomed.2021.104572] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022]
Abstract
We present a machine learning based COVID-19 cough classifier which can discriminate COVID-19 positive coughs from both COVID-19 negative and healthy coughs recorded on a smartphone. This type of screening is non-contact, easy to apply, and can reduce the workload in testing centres as well as limit transmission by recommending early self-isolation to those who have a cough suggestive of COVID-19. The datasets used in this study include subjects from all six continents and contain both forced and natural coughs, indicating that the approach is widely applicable. The publicly available Coswara dataset contains 92 COVID-19 positive and 1079 healthy subjects, while the second smaller dataset was collected mostly in South Africa and contains 18 COVID-19 positive and 26 COVID-19 negative subjects who have undergone a SARS-CoV laboratory test. Both datasets indicate that COVID-19 positive coughs are 15%–20% shorter than non-COVID coughs. Dataset skew was addressed by applying the synthetic minority oversampling technique (SMOTE). A leave-p-out cross-validation scheme was used to train and evaluate seven machine learning classifiers: logistic regression (LR), k-nearest neighbour (KNN), support vector machine (SVM), multilayer perceptron (MLP), convolutional neural network (CNN), long short-term memory (LSTM) and a residual-based neural network architecture (Resnet50). Our results show that although all classifiers were able to identify COVID-19 coughs, the best performance was exhibited by the Resnet50 classifier, which was best able to discriminate between the COVID-19 positive and the healthy coughs with an area under the ROC curve (AUC) of 0.98. An LSTM classifier was best able to discriminate between the COVID-19 positive and COVID-19 negative coughs, with an AUC of 0.94 after selecting the best 13 features from a sequential forward selection (SFS). Since this type of cough audio classification is cost-effective and easy to deploy, it is potentially a useful and viable means of non-contact COVID-19 screening.
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Affiliation(s)
- Madhurananda Pahar
- Department of Electrical and Electronic Engineering, Stellenbosch University, South Africa.
| | - Marisa Klopper
- SAMRC Centre for Tuberculosis Research, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Robin Warren
- SAMRC Centre for Tuberculosis Research, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Thomas Niesler
- Department of Electrical and Electronic Engineering, Stellenbosch University, South Africa.
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27
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Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, Bush A, Chalmers JD, Hill AT, Karadag B, Midulla F, McCallum GB, Powell Z, Snijders D, Song WJ, Tonia T, Wilson C, Zacharasiewicz A, Kantar A. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:13993003.02990-2020. [PMID: 33542057 DOI: 10.1183/13993003.02990-2020] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Leanne Bell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
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28
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Chang AB, Toombs M, Chatfield MD, Mitchell R, Fong SM, Binks MJ, Smith-Vaughan H, Pizzutto SJ, Lust K, Morris PS, Marchant JM, Yerkovich ST, O'Farrell H, Torzillo PJ, Maclennan C, Simon D, Unger HW, Ellepola H, Odendahl J, Marshall HS, Swamy GK, Grimwood K. Study Protocol for Preventing Early-Onset Pneumonia in Young Children Through Maternal Immunisation: A Multi-Centre Randomised Controlled Trial (PneuMatters). Front Pediatr 2021; 9:781168. [PMID: 35111703 PMCID: PMC8802227 DOI: 10.3389/fped.2021.781168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Preventing and/or reducing acute lower respiratory infections (ALRIs) in young children will lead to substantial short and long-term clinical benefits. While immunisation with pneumococcal conjugate vaccines (PCV) reduces paediatric ALRIs, its efficacy for reducing infant ALRIs following maternal immunisation has not been studied. Compared to other PCVs, the 10-valent pneumococcal-Haemophilus influenzae Protein D conjugate vaccine (PHiD-CV) is unique as it includes target antigens from two common lower airway pathogens, pneumococcal capsular polysaccharides and protein D, which is a conserved H. influenzae outer membrane lipoprotein. Aims: The primary aim of this randomised controlled trial (RCT) is to determine whether vaccinating pregnant women with PHiD-CV (compared to controls) reduces ALRIs in their infants' first year of life. Our secondary aims are to evaluate the impact of maternal PHiD-CV vaccination on different ALRI definitions and, in a subgroup, the infants' nasopharyngeal carriage of pneumococci and H. influenzae, and their immune responses to pneumococcal vaccine type serotypes and protein D. Methods: We are undertaking a parallel, multicentre, superiority RCT (1:1 allocation) at four sites across two countries (Australia, Malaysia). Healthy pregnant Australian First Nation or Malaysian women aged 17-40 years with singleton pregnancies between 27+6 and 34+6 weeks gestation are randomly assigned to receive either a single dose of PHiD-CV or usual care. Treatment allocation is concealed. Study outcome assessors are blinded to treatment arms. Our primary outcome is the rate of medically attended ALRIs by 12-months of age. Blood and nasopharyngeal swabs are collected from infants at birth, and at ages 6- and 12-months (in a subset). Our planned sample size (n = 292) provides 88% power (includes 10% anticipated loss to follow-up). Discussion: Results from this RCT potentially leads to prevention of early and recurrent ALRIs and thus preservation of lung health during the infant's vulnerable period when lung growth is maximum. The multicentre nature of our study increases the generalisability of its future findings and is complemented by assessing the microbiological and immunological outcomes in a subset of infants. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374381, identifier: ACTRN12618000150246.
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Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Maree Toombs
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Siew M Fong
- Division of Paediatric Infectious Diseases, Hospital Likas, Kota Kinabalu, Malaysia
| | - Michael J Binks
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Heidi Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Susan J Pizzutto
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Karin Lust
- Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul J Torzillo
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carolyn Maclennan
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Simon
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Holger W Unger
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Hasthika Ellepola
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Jens Odendahl
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Geeta K Swamy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, NC, United States
| | - Keith Grimwood
- Department of Infectious Disease and Paediatrics, Gold Coast Health, Southport, QLD, Australia.,School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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29
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Li Q, Guo Z, Li Y, Zhang G, Tian X, Gu R, Luo Z. Diagnosis and management of protracted bacterial bronchitis: a survey of Chinese pediatricians. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:46. [PMID: 33553339 PMCID: PMC7859824 DOI: 10.21037/atm-20-3984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children. However, it is often misdiagnosed and inappropriately treated in clinical practices. This study aims to investigate the current diagnosis and management of PBB among Chinese pediatricians. Methods An electronic questionnaire designed to assess the diagnosis and management of PBB was sent to pediatricians in China. Results A total of 1,022 pediatricians completed the questionnaire. Most (68.8%) of the pediatricians diagnosed PBB in compliance with the guidelines, 44.3% and 24.5% of them followed microbiology-based and clinical-based diagnosis criteria, respectively. Only 40.4% of the pediatricians chose amoxicillin-clavulanate as the first-line antibiotic for PBB treatment, 23.7% and 23.5% of them chose third-generation cephalosporins and macrolides, respectively. The majority of pediatricians (75.4%) reported 2–4 weeks of antibiotics course, 19.3% of them prescribed a shorter course and 5% of them selected a longer course. Only 26.3% of the pediatricians performed combined investigations of chest high-resolution computed tomography scan (c-HRCT), bronchoscopy, and immunological tests for recurrences of PBB. Compared with general pediatricians (GP), pediatric pulmonologists (PP) preferred microbiology-based diagnosis criteria, prescribed more amoxicillin-clavulanate, and performed more investigations for recurrent patients (P<0.05). Conclusions The majority of Chinese pediatricians diagnosed PBB in compliance with guidelines. However, the reasonable antibiotics applications and the investigations for recurrent PBB need to be improved.
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Affiliation(s)
- Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ziyao Guo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guangli Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoyin Tian
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ruixue Gu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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30
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Stafler P, Zaks-Hoffer G, Scheuerman O, Ben-Zvi H, Mussaffi H, Mei-Zahav M, Steuer G, Levine H, Bar-On O, Mantin H, Prais D, Blau H. Diagnostic value of sputum cultures in children under 2 years of age with chronic suppurative lung diseases. Pediatr Pulmonol 2020; 55:3421-3428. [PMID: 33006230 DOI: 10.1002/ppul.25103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acquiring sputum cultures from infants is considered challenging. We describe their yield in infants with cystic fibrosis (CF) and other chronic suppurative lung diseases (CSLDs). METHODS Retrospective medical record review over a 4-year period, for infants aged 0-2 years with ≥2 airway bacterial cultures acquired by deep suction or induced sputum ≥4 weeks apart. Data included demographics, culture results, and clinical status. RESULTS A total of 98 infants (16 CF) were evaluated and 534 sputum cultures acquired, 201 in CF and 333 in CSLD. There were 12 (2-23), median (range) cultures/CF infant, and 3 (2-21)/CSLD infant. Age at first culture was 3.8 (1-19.5) months for CF and 10.4 (0.5-22) months for CSLD; p = .016. In total, 360 cultures (67%) were positive for any bacteria, with 170/234 (73%) positive during exacerbations, compared with 190/300 (63%) during routine visits; p = .05. More infants with CF than CSLD had cultures positive for Staphylococcus aureus (SA; 75% vs. 34%; p = .004) throughout the period. Pseudomonas aeruginosa (PA) was common in both CF and CSLD (56% and 44%, respectively; p = .42) and increased over time for CF but was high throughout for CSLD. The number of hospital days before PA acquisition was 6 (10.2) for CF and 28.8 (38.7) for CSLD (p = .003). No CF but 6/82 (7%) CSLD infants had chronic PA (p = .56). CONCLUSIONS Sputum cultures showed that infection, in particular PA, is common in CF and CSLD whereas SA is more common in CF. Prospective studies are warranted to elucidate the role of active surveillance in guiding antibiotic therapy.
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Affiliation(s)
- Patrick Stafler
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gal Zaks-Hoffer
- Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Genetics Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | - Huda Mussaffi
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Hagit Levine
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ophir Bar-On
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hadas Mantin
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dario Prais
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hannah Blau
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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31
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Ruffles TJC, Marchant JM, Masters IB, Yerkovich ST, Wurzel DF, Gibson PG, Busch G, Baines KJ, Simpson JL, Smith-Vaughan HC, Pizzutto SJ, Buntain HM, Hodge G, Hodge S, Upham JW, Chang AB. Outcomes of protracted bacterial bronchitis in children: A 5-year prospective cohort study. Respirology 2020; 26:241-248. [PMID: 33045125 DOI: 10.1111/resp.13950] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-term data on children with PBB has been identified as a research priority. We describe the 5-year outcomes for children with PBB to ascertain the presence of chronic respiratory disease (bronchiectasis, recurrent PBB and asthma) and identify the risk factors for these. METHODS Prospective cohort study was undertaken at the Queensland Children's Hospital, Brisbane, Australia, of 166 children with PBB and 28 controls (undergoing bronchoscopy for symptoms other than chronic wet cough). Monitoring was by monthly contact via research staff. Clinical review, spirometry and CT chest were performed as clinically indicated. RESULTS A total of 194 children were included in the analysis. Median duration of follow-up was 59 months (IQR: 50-71 months) post-index PBB episode, 67.5% had ongoing symptoms and 9.6% had bronchiectasis. Significant predictors of bronchiectasis were recurrent PBB in year 1 of follow-up (ORadj = 9.6, 95% CI: 1.8-50.1) and the presence of Haemophilus influenzae in the BAL (ORadj = 5.1, 95% CI: 1.4-19.1). Clinician-diagnosed asthma at final follow-up was present in 27.1% of children with PBB. A significant BDR (FEV1 improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen-specific IgE (ORadj = 14.8, 95% CI: 2.2-100.8) at baseline and bronchomalacia (ORadj = 5.9, 95% CI: 1.2-29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. CONCLUSION As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required.
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Affiliation(s)
- Tom J C Ruffles
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Academic Department of Paediatrics, The Royal Alexandra Children's Hospital, Brighton and Sussex Medical School, Brighton, UK
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ian B Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Danielle F Wurzel
- Infection and Immunity, Murdoch Children's Research Institute; Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Greta Busch
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen M Buntain
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - John W Upham
- The University of Queensland Diamantina Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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32
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Zacharasiewicz A. Chronischer Husten bei Kindern. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Gao YH, Chalmers JD. Counting the cost of bronchiectasis. Respirology 2020; 25:1223-1224. [PMID: 32608039 DOI: 10.1111/resp.13888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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34
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Douros K, Everard ML. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. Front Pediatr 2020; 8:218. [PMID: 32432064 PMCID: PMC7214804 DOI: 10.3389/fped.2020.00218] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a "viral bronchitis" and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a "snotty lung"). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs.
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Affiliation(s)
- Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Mark L. Everard
- Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
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35
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Gilchrist FJ, Ali I, Brodlie M, Carroll WD, Kemball B, Walker J, Sinha I. Developing a core outcome set for children with protracted bacterial bronchitis. ERJ Open Res 2020; 6:00344-2019. [PMID: 32055628 PMCID: PMC7008134 DOI: 10.1183/23120541.00344-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Protracted bacterial bronchitis (PBB) is a chronic endobrochial infection and a leading cause of chronic wet cough in children. There is an urgent need for a randomised controlled trial to investigate the optimal treatment but there is no core outcome set (COS) to inform choice of outcomes. A COS is a standardised set of outcomes representing the minimum that should be measured and reported in clinical trials of a specific condition. We have developed a COS for PBB. Methods Potential core outcomes were collated from a systematic review, interviews with parents and a clinician survey. A two-round Delphi survey of healthcare professionals identified which outcomes had consensus for inclusion. The final COS was agreed at a consensus meeting of parent representatives and clinicians. Results 20 outcomes were identified for the Delphi survey. After two rounds, 10 reached consensus. These were combined and edited at the consensus meeting into the final six: 1) Resolution of cough assessed using a cough score/diary recorded daily by parent(s) during treatment; 2) relapse of chronic wet cough and/or cumulative antibiotic treatment during ≥12 months follow-up; 3) change in child's quality of life (parent-proxy reporting for young children); 4) emergence of antibiotic resistance; 5) development of bronchiectasis diagnosed on clinically indicated computed tomography scans; and 6) microbiological clearance of identified respiratory pathogen if samples readily available. Conclusions We have developed a COS for PBB which will reduce the outcome heterogeneity and bias of future clinical trials, as well as promoting comparison between studies. A core outcome set for protracted bacterial bronchitis in children that will reduce outcome heterogeneity and bias in future clinical trials and promote meta-analysishttp://bit.ly/2PDQvHL
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Affiliation(s)
- Francis J Gilchrist
- Institute of Applied Clinical Science, Keele University, Keele, UK.,Paediatric Respiratory Services, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Imran Ali
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Malcolm Brodlie
- Dept of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Will D Carroll
- Institute of Applied Clinical Science, Keele University, Keele, UK.,Paediatric Respiratory Services, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Bridget Kemball
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - James Walker
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Ian Sinha
- Dept of Paediatric Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
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36
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Gallucci M, Pedretti M, Giannetti A, di Palmo E, Bertelli L, Pession A, Ricci G. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr 2020; 8:433. [PMID: 32850546 PMCID: PMC7426454 DOI: 10.3389/fped.2020.00433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic cough is defined as a daily cough that persists longer than 4 weeks. Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.
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Affiliation(s)
- Marcella Gallucci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Melissa Pedretti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arianna Giannetti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Bertelli
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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37
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Laird P, Totterdell J, Walker R, Chang AB, Schultz A. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children. ERJ Open Res 2019; 5:00248-2019. [PMID: 31832431 PMCID: PMC6899340 DOI: 10.1183/23120541.00248-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Chronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia. Methods A whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics). Results Of the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%). Conclusion Given the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children in remote, north Western Australia is high. There is a need to implement strategies to detect and manage these entities and measure prevalence in other settings.http://bit.ly/33QLzDA
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Affiliation(s)
- Pamela Laird
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,Dept of Physiotherapy, Perth Children's Hospital, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia
| | - James Totterdell
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia
| | - Roz Walker
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia
| | - André Schultz
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia.,Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia
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38
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Wong OY, Marchant JM, Yerkovich ST, Chang AB. Predictors of time to cough resolution in children with chronic wet cough treated with antibiotics after bronchoscopy. Pediatr Pulmonol 2019; 54:1997-2002. [PMID: 31496125 DOI: 10.1002/ppul.24506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/21/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic wet cough is common in pediatric pulmonology practice and is clinically important. Guidelines recommend treatment with antibiotics as their effectiveness has been proven. However, factors associated with duration of cough in response to antibiotics in children with chronic wet cough have not been prospectively examined. OBJECTIVE To determine if demographic, clinical and/or bronchoalveolar lavage (BAL) factors are associated with "time to cough resolution" in children with chronic wet cough treated with antibiotics after bronchoscopy. METHODS Data from children with chronic wet cough treated with antibiotics after bronchoscopy were extracted from a prospective cohort study database. Cough dairies were used to determine when the cough resolved. Associations between various factors with "time to cough resolution" were examined using regression. RESULTS The median age of the 133 children was 2.4 years (interquartile range, 1.4-4.9). Duration of prior cough at bronchoscopy was significantly positively related with "time to cough resolution" (β = .010; 95% confidence interval, 0.004-0.017; P = .002). This translated to; for each month of prior cough, it took an extra 1.02 days to achieve cough resolution while on antibiotic treatment. Gender, age, diagnosis, tobacco smoke exposure, pneumonia history, blood cellularity, and BAL cellular and microbiology profiles were not significantly associated with time to cough resolution. CONCLUSION In children with chronic wet cough, duration of cough before antibiotic treatment is a small but significant determinant of "time to cough resolution." Research using standardized antibiotic regimes is required to provide clinical and/or biomarkers that can further identify factors associated with the response of chronic cough to antibiotic treatment.
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Affiliation(s)
- Oi Yin Wong
- Department of Paediatric and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.,Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Anne B Chang
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Seidl E, Kiermeier H, Liebisch G, Ballmann M, Hesse S, Paul-Buck K, Ratjen F, Rietschel E, Griese M. Lavage lipidomics signatures in children with cystic fibrosis and protracted bacterial bronchitis. J Cyst Fibros 2019; 18:790-795. [DOI: 10.1016/j.jcf.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/08/2019] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
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O'Grady KAF, Grimwood K, Torzillo PJ, Rablin S, Lovie-Toon Y, Kaus M, Arnold D, Roberts J, Buntain H, Adsett D, King A, Scott M, Anderson J, Toombs M, Chang AB. Effectiveness of a chronic cough management algorithm at the transitional stage from acute to chronic cough in children: a multicenter, nested, single-blind, randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:889-898. [PMID: 31635952 DOI: 10.1016/s2352-4642(19)30327-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic (lasting at least 4 weeks) cough in children is an important cause of morbidity. An algorithmic approach to the management of coughs in children evaluated in observational studies and a randomised controlled trial (RCT) enrolled children referred with median cough duration of 16 weeks to specialist centres. We investigated whether applying an evidence-based cough management algorithm in non-specialist settings earlier, once cough persisted for more than 4 weeks, improved cough resolution compared with usual care. METHODS We undertook a multicentre, single-blind RCT nested within a prospective cohort study of children (<15 years) in Australia presenting to three primary care or three hospital emergency departments with an acute respiratory illness with cough. Children were excluded if they had a known diagnosis of an underlying chronic medical condition (excluding asthma) or had an immunosuppressive illness or were taking immunomodulating drugs for more than 2 weeks in the preceding 30 days, or had severe symptoms requiring inpatient hospitalisation. Children were followed up for 8 weeks; those with a persistent cough at day 28 were randomly assigned to the cough management algorithm or to usual care. Randomisation was stratified by reason for presentation, study site, and cough duration (4 weeks to <6 weeks vs ≥6 weeks) using computer-generated permuted blocks (block size of four) with a 1:1 allocation. The primary outcome was the proportion of children with cough resolution at day 56 (defined as resolved if the child did not cough for at least 3 days and nights since day 28 or a more than 75% reduction in their average day and night cough score). Absolute risk differences (RDabsolute) were calculated by modified intention-to-treat analysis (ITT). This trial is registered with the Australia New Zealand Clinical Trials Registry, ACTRN12615000132549. FINDINGS Between July 7, 2015, and Oct 31, 2018, 1018 children were screened, 509 were enrolled in the cohort study, and of 115 children in the ITT analysis, 57 were randomly assigned to the intervention group and 58 to the control group. Children had a median age of 1·6 years (IQR 1·0-4·5); 45 (39%) of 115 were Indigenous, and 59 (51%) were boys. By day 56, 33 (58%) of 57 children in the intervention group achieved cough resolution compared with 23 (40%) 58 in the control group; cough resolution was unknown in 12 (21%) of 57 children receiving the intervention and in 13 (22%) of 58 receiving the control. The RDabsolute assuming children with an unknown cough outcome were still coughing at day 56 was 18·3% (95% CI 0·3-36·2); the number needed-to-treat for benefit was five (95% CI 3-364); the adjusted odds ratio was 1·5 (95% CI 1·3-1·6), favouring the intervention group. INTERPRETATION This study suggests an evidence-based cough management algorithm improves cough resolution in community-based children in the early phases of chronic cough. However, larger studies to confirm these findings in primary care are required. FUNDING National Health and Medical Research Council.
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Affiliation(s)
- Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia.
| | - Keith Grimwood
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Paul J Torzillo
- Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sheree Rablin
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Yolanda Lovie-Toon
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Michelle Kaus
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Daniel Arnold
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Jack Roberts
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Helen Buntain
- Wesley Medical Centre, Auchenflower, QLD, Australia; Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Don Adsett
- 78 Margaret Street, Toowoomba, QLD, Australia
| | - Alex King
- The Toowoomba Hospital, Toowoomba, QLD, Australia
| | - Mark Scott
- Caboolture Hospital, Caboolture, QLD, Australia
| | - Jennie Anderson
- Caboolture Community Medical Centre, Caboolture, QLD, Australia
| | - Maree Toombs
- UQ Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Anne B Chang
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, QLD, Australia; Menzies School of Health Research, Charles Darwin University, Darwin Northern Territory, Australia; Department of Respiratory Medicine, QLD Children's Hospital, South Brisbane, QLD, Australia
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Chang AB, Marchant JM. Protracted bacterial bronchitis is a precursor for bronchiectasis in children: myth or maxim? Breathe (Sheff) 2019; 15:167-170. [PMID: 31508153 PMCID: PMC6717611 DOI: 10.1183/20734735.0178-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recognising the link between protracted bacterial bronchitis and bronchiectasis creates an opportunity to understand the pathobiology of early suppurative endobronchial lung disease and prospects for the development of effective and early interventions http://bit.ly/2K3ikI6.
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Affiliation(s)
- Anne B. Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
- Center for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Julie M. Marchant
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
- Center for Children's Health Research, Queensland University of Technology, Brisbane, Australia
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Abstract
Introduction: Bronchiectasis is increasingly recognized as a major cause of morbidity and mortality worldwide. It affects children of all ethnicities and socioeconomic backgrounds and represents a far greater burden than cystic fibrosis (CF). Bronchiectasis often begins in childhood and the radiological changes can be reversed, when mild, with optimal management. As there are limited pediatric studies in this field, current treatment approaches in children are based largely upon adult and/or CF studies. The recent establishment of bronchiectasis registries will improve understanding of pediatric bronchiectasis and increase capacity for large-scale research studies in the future. Areas covered: This review summarizes the current management of bronchiectasis in children and highlights important knowledge gaps and areas for future research. Current treatment approaches are based largely on consensus guidelines from international experts in the field. Studies were identified through searching Medline via the Ovid interface and Pubmed using the search terms 'bronchiectasis' and 'children' or 'pediatric' and 'management' or 'treatments'. Expert opinion: Bronchiectasis is heterogeneous in nature and a one-size-fits-all approach has limitations. Future research should focus on advancing our understanding of the aetiopathogenesis of bronchiectasis. This approach will facilitate development of targetted therapeutic interventions to slow, halt or even reverse bronchiectasis in childhood.
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Affiliation(s)
- Johnny Wu
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Melbourne , Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Children Centre for Health Research, Queensland University of Technology , Brisbane , Australia.,Child Health Division, Menzies School of Health Research , Darwin , NT , Australia
| | - Danielle F Wurzel
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Melbourne , Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital , Melbourne , Australia.,Infection and Immunity, The Murdoch Children's Research Institute , Melbourne , Australia
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43
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Gilchrist FJ. An approach to the child with a wet cough. Paediatr Respir Rev 2019; 31:75-81. [PMID: 30584049 DOI: 10.1016/j.prrv.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/05/2018] [Accepted: 11/16/2018] [Indexed: 12/30/2022]
Abstract
When children have a wet cough, it suggests the presence of secretions in their airways. This often has an infectious aetiology which is usually a self-limiting viral infection requiring no investigation or treatment. In those with acute wet cough it is, however, important to identify features suggestive of community acquired pneumonia or an inhaled foreign body as these causes require specific management. When there is chronic wet cough, the most common diagnoses are protracted bacterial bronchitis (PBB) and bronchiectasis. The relationship between these two conditions is complex as the development of bronchiectasis manifests as a clinical continuum in which the early features of which are indistinguishable from PBB. It is therefore important to identify PBB and chronic cough endotypes which are associated with an increased risk of bronchiectasis. This article offers a pragmatic approach to the investigation and treatment of children with wet cough. It is hoped this will limit unnecessary investigations whist aiding the prompt diagnosis of conditions needing treatment to reduce symptom burden and prevent further lung damage.
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Affiliation(s)
- F J Gilchrist
- Institute of Applied Clinical Science, Keele University, Keele ST5 5BG, UK; Academic Department of Child Health, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke on Trent ST4 6QG, UK.
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Laird P, Walker R, Lane M, Chang AB, Schultz A. We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children. Respirology 2019; 25:383-392. [DOI: 10.1111/resp.13642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/03/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Pamela Laird
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
| | - Roz Walker
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service Broome WA Australia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health ResearchCharles Darwin University Darwin NT Australia
| | - André Schultz
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
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Hare KM, Seib KL, Chang AB, Harris TM, Spargo JC, Smith-Vaughan HC. Antimicrobial susceptibility and impact of macrolide antibiotics on Moraxella catarrhalis in the upper and lower airways of children with chronic endobronchial suppuration. J Med Microbiol 2019; 68:1140-1147. [PMID: 31274402 DOI: 10.1099/jmm.0.001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Moraxella catarrhalis is an important but insufficiently studied respiratory pathogen. AIM To determine antibiotic susceptibility and impact of recent antibiotics on M. catarrhalis from children with chronic endobronchial suppuration. METHODOLOGY We cultured nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids collected from children who were prospectively enrolled in studies of chronic cough and had flexible bronchoscopy performed. Recent β-lactam or macrolide antibiotic use was recorded. M. catarrhalis isolates stored at -80 °C were re-cultured and susceptibility determined to a range of antibiotics including the macrolide antibiotic erythromycin. RESULTS Data from concurrently collected NP and BAL specimens were available from 547 children (median age 2.4 years) enrolled from 2007 to 2016. M. catarrhalis NP carriage was detected in 149 (27 %) children and lower airway infection (≥104 c.f.u. ml-1 BAL) in 67 (12 %) children. In total, 91 % of 222 M. catarrhalis isolates were β-lactamase producers, and non-susceptibility was high to benzylpenicillin (98 %), cefaclor (39 %) and cotrimoxazole (38 %). Overall, >97 % isolates were susceptible to cefuroxime, chloramphenicol, erythromycin and tetracycline; three isolates were erythromycin-resistant (MIC >0.5 mg l-1). Recent macrolide antibiotics (n=152 children, 28 %) were associated with significantly reduced M. catarrhalis carriage and lower airway infection episodes compared to children who did not receive macrolides; odds ratios 0.19 (95 % CI 0.10-0.35) and 0.15 (0.04-0.41), respectively. CONCLUSION Despite the frequent use of macrolides, few macrolide-resistant isolates were detected. This suggests a fitness cost associated with macrolide resistance in M. catarrhalis. Macrolide antibiotics remain an effective choice for treating M. catarrhalis lower airway infection in children with chronic endobronchial suppuration.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, 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
| | - Tegan M Harris
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Jessie C Spargo
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
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D'Sylva P, Walker R, Lane M, Chang AB, Schultz A. Chronic wet cough in Aboriginal children: It's not just a cough. J Paediatr Child Health 2019; 55:833-843. [PMID: 30444010 DOI: 10.1111/jpc.14305] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/13/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022]
Abstract
AIM Chronic respiratory disease is common among Aboriginal Australians. Chronic wet cough is an early marker of chronic disease in children but often goes undetected due, in part, to delayed health seeking by families. Currently, no studies have examined the reasons for delayed health seeking for children's chronic cough. To identify the barriers to, and enablers for, seeking medical help for chronic wet cough in Aboriginal children. METHODS This was a qualitative study, gathering data through individual semi-structured, in-depth interviews and focus groups to ascertain Aboriginal family knowledge, attitudes and beliefs about seeking health care for chronic wet cough in children in a regional Kimberley town, Western Australia between October 2017 and March 2018. RESULTS Forty Aboriginal community members participated. The three key barriers identified were: 'Cough normalisation', that is, 70% of participants considered chronic cough normal (with 53% of participants' previous interactions with doctors informing their understanding of chronic cough); the lack of health literacy information; and a sense of disempowerment (belief that no medical action would be taken and inability to challenge doctors). The key expressed enablers were provision of health literacy information and health practitioner training to assess and treat chronic wet cough in children. All participants reported that they would seek help for chronic wet cough once they were informed that it could signify underlying disease. CONCLUSION Results highlight the need for a culturally appropriate information and education to inform Aboriginal families and their health practitioners of the importance of chronic wet cough in children.
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Affiliation(s)
- Pamela D'Sylva
- Child Health, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Kulunga Aboriginal Research Development Unit, Telethon Kids Institute, Perth, Western Australia, Australia.,Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roz Walker
- Kulunga Aboriginal Research Development Unit, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Mary Lane
- Broome Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - André Schultz
- Child Health, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Kulunga Aboriginal Research Development Unit, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
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47
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Hare KM, Chang AB, Smith-Vaughan HC, Bauert PA, Spain B, Beissbarth J, Grimwood K. Do combined upper airway cultures identify lower airway infections in children with chronic cough? Pediatr Pulmonol 2019; 54:907-913. [PMID: 31006971 DOI: 10.1002/ppul.24336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obtaining lower airway specimens is important for guiding therapy in chronic lung infection but is difficult in young children unable to expectorate. While culture-based studies have assessed the diagnostic accuracy of nasopharyngeal or oropharyngeal specimens for identifying lower airway infection, none have used both together. We compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs with bronchoalveolar lavage (BAL) cultures as the "gold standard" to better inform the diagnosis of lower airway infection in children with chronic wet cough. METHODS Nasopharyngeal and oropharyngeal swabs and BAL fluid specimens were collected concurrently from consecutive children undergoing flexible bronchoscopy for chronic cough and cultured for bacterial pathogens. RESULTS In cultures from 309 children (median age, 2.3 years) with chronic endobronchial suppuration, all main pathogens detected (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) were more prevalent in nasopharyngeal than oropharyngeal swabs (37%, 34%, and 23% vs 21%, 6.2%, and 3.2%, respectively). Positive and negative predictive values for lower airway infection by any of these three pathogens were 63% (95% confidence interval [95% CI] 55, 70) and 85% (95% CI, 78, 91) for nasopharyngeal swabs, 65% (95% CI, 54, 75), and 66% (95% CI, 59, 72) for oropharyngeal swabs, and 61% (95% CI, 54,68), and 88% (95% CI, 81, 93) for both swabs, respectively. CONCLUSIONS Neither nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predicted lower airway infection in children with chronic wet cough. Although upper airway specimens may be useful for bacterial carriage studies and monitoring antimicrobial resistance, their clinical utility in pediatric chronic lung disorders of endobronchial suppuration is limited.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Paul A Bauert
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Brian Spain
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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Donnelly D, Everard ML. 'Dry' and 'wet' cough: how reliable is parental reporting? BMJ Open Respir Res 2019; 6:e000375. [PMID: 31178996 PMCID: PMC6530544 DOI: 10.1136/bmjresp-2018-000375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of 'wheeze' is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child's cough is likely to be accurate. Methods Parents of 48 'new' patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child's cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video. Results In a quarter of cases, the parents chose a video clip of a 'dry' or 'wet' cough having given the opposite description. In a further 20% parents chose examples of both 'dry' and 'wet' coughs despite having used only one descriptor. Discussion While the characteristics of a child's cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child's cough with some caution in that one person's 'dry' cough may very well be another person's 'wet' cough.
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Affiliation(s)
- Deirdre Donnelly
- Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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Chang AB, Fong SM, Yeo TW, Ware RS, McCallum GB, Nathan AM, Ooi MH, de Bruyne J, Byrnes CA, Lee B, Nachiappan N, Saari N, Torzillo P, Smith-Vaughan H, Morris PS, Upham JW, Grimwood K. HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial. BMJ Open 2019; 9:e026411. [PMID: 31023759 PMCID: PMC6502017 DOI: 10.1136/bmjopen-2018-026411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/06/2018] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually <2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode. METHODS AND ANALYSIS This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are 'clinical cure' at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria. ETHICS AND DISSEMINATION The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children's and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication. TRIAL REGISTRATION ACTRN12616000046404.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin Univ, Darwin, Northern Territory, Australia
- Qld Children's Hospital, Brisbane, Queensland, Australia
| | | | - Tsin Wen Yeo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Mong H Ooi
- Universiti Malaysia Sarawak, Kuching, Malaysia
| | | | | | - Bilawara Lee
- Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Paul Torzillo
- Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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50
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Affiliation(s)
- Ajay S Kasi
- Division of Pediatric Pulmonology, Department of Pediatrics, Emory University, Atlanta, GA
| | - Rory J Kamerman-Kretzmer
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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