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Chang AB, Yerkovich ST, Baines KJ, Burr L, Champion A, Chatfield MD, Eg KP, Goyal V, Marsh RL, McCallum GB, McElrea M, McPhail S, Morgan LC, Morris PS, Nathan AM, O'Farrell H, Sanchez MO, Parsons M, Schultz A, Torzillo PJ, West NP, Versteegh L, Marchant JM, Grimwood K. Erdosteine in children and adults with bronchiectasis (BETTER trial): study protocol for a multicentre, double-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e002216. [PMID: 38719503 PMCID: PMC11086403 DOI: 10.1136/bmjresp-2023-002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Bronchiectasis is a worldwide chronic lung disorder where exacerbations are common. It affects people of all ages, but especially Indigenous populations in high-income nations. Despite being a major contributor to chronic lung disease, there are no licensed therapies for bronchiectasis and there remain relatively few randomised controlled trials (RCTs) conducted in children and adults. Our RCT will address some of these unmet needs by evaluating whether the novel mucoactive agent, erdosteine, has a therapeutic role in children and adults with bronchiectasis.Our primary aim is to determine in children and adults aged 2-49 years with bronchiectasis whether regular erdosteine over a 12-month period reduces acute respiratory exacerbations compared with placebo. Our primary hypothesis is that people with bronchiectasis who regularly use erdosteine will have fewer exacerbations than those receiving placebo.Our secondary aims are to determine the effect of the trial medications on quality of life (QoL) and other clinical outcomes (exacerbation duration, time-to-next exacerbation, hospitalisations, lung function, adverse events). We will also assess the cost-effectiveness of the intervention. METHODS AND ANALYSIS We are undertaking an international multicentre, double-blind, placebo-RCT to evaluate whether 12 months of erdosteine is beneficial for children and adults with bronchiectasis. We will recruit 194 children and adults with bronchiectasis to a parallel, superiority RCT at eight sites across Australia, Malaysia and Philippines. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, exacerbation duration, time-to-next exacerbation, hospitalisations and lung function. ETHICS AND DISSEMINATION The Human Research Ethics Committees (HREC) of Children's Health Queensland (for all Australian sites), University of Malaya Medical Centre (Malaysia) and St. Luke's Medical Centre (Philippines) approved the study. We will publish the results and share the outcomes with the academic and medical community, funding and relevant patient organisations. TRIAL REGISTRATION NUMBER ACTRN12621000315819.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Katherine J Baines
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Immune Health Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Lucy Burr
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Anita Champion
- Department of Pharmacy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Kah P Eg
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Vikas Goyal
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Robyn L Marsh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Gabrielle B McCallum
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Margaret McElrea
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven McPhail
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia
- Metro South Health, Clinical Informatics Directorate, Woollongabba, Queensland, Australia
| | - Lucy C Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Peter S Morris
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne M Nathan
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Hannah O'Farrell
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Marion O Sanchez
- Section of Pediatric Pulmonology, Institute of Pulmonary Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | - Marianne Parsons
- Parent Advisory Group, Cough, Asthma and Airways Group, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - André Schultz
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute & Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paul J Torzillo
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nicholas P West
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
| | - Lesley Versteegh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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Hussein MM, Fouda EM, Shehab Y, Nabih ES, Osman AM, Ishak SR. Association between arachidonate lipoxygenase 15,c.-292 C > T gene polymorphism and non-cystic fibrosis bronchiectasis in children: a pilot study on the effects on airway lipoxin A4 and disease phenotype. Ital J Pediatr 2024; 50:90. [PMID: 38685084 PMCID: PMC11059722 DOI: 10.1186/s13052-024-01654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Persistent airway inflammation is a central feature of bronchiectasis. Arachidonate 15-lipoxygenase (ALOX-15) controls production of endogenous lipid mediators, including lipoxins that regulate airway inflammation. Mutations at various positions in ALOX-15 gene can influence airway disease development. We investigated association between ALOX-15,c.-292 C > T gene polymorphism and bronchiectasis unrelated to cystic fibrosis in Egyptian children. Also, lipoxin A4 (LXA4) level in bronchoalveolar lavage (BAL) was studied in relation to polymorphism genotypes and disease phenotypes determined by clinical, pulmonary functions, and radiological severity parameters. METHODS This was an exploratory study that included 60 participants. Thirty children with non-cystic fibrosis bronchiectasis (NCFB) were compared with 30 age and sex-matched controls. ALOX-15,c.-292 C > T polymorphism was genotyped using TaqMan-based Real-time PCR. LXA4 was measured in BAL using ELISA method. RESULTS There was no significant difference between patients and controls regarding ALOX-15,c.-292 C > T polymorphism genotypes and alleles (OR = 1.75; 95% CI (0.53-5.7), P = 0.35) (OR = 1; 95% CI (0.48-2), p = 1). BAL LXA4 level was significantly lower in patients, median (IQR) of 576.9 (147.6-1510) ng/ml compared to controls, median (IQR) of 1675 (536.8-2542) (p = 0.002). Patients with severe bronchiectasis had a significantly lower LXA4 level (p < 0.001). There were significant correlations with exacerbations frequency (r=-0.54, p = 0.002) and FEV1% predicted (r = 0.64, p = 0.001). Heterozygous CT genotype carriers showed higher LXA4 levels compared to other genotypes(p = 0.005). CONCLUSIONS Low airway LXA4 in children with NCFB is associated with severe disease phenotype and lung function deterioration. CT genotype of ALOX-15,c.-292 C > T polymorphism might be a protective genetic factor against bronchiectasis development and/or progression due to enhanced LXA4 production.
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Affiliation(s)
| | - Eman Mahmoud Fouda
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasmine Shehab
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Enas Samir Nabih
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Mohamed Osman
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sally Raafat Ishak
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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3
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Ding F, Pan Z, Wu C, Li H, Li Y, An Y, Dai J, Wang G, Liu B. Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children. Ther Adv Respir Dis 2024; 18:17534666241228159. [PMID: 38327061 PMCID: PMC10851711 DOI: 10.1177/17534666241228159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial. OBJECTIVES The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis. DESIGN Retrospective single-center cohort study. METHODS A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information. RESULTS There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493). CONCLUSION The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.
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Affiliation(s)
- Fengxia Ding
- 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Yong An
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
| | - Bo Liu
- Department of Cardiothoracic Surgery, 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, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, No. 136, Zhongshan Second Road, Yuzhong, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, China
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Aloui M, Er-rajy M, Imtara H, Goudzal A, Zarougui S, El fadili M, Arthur DE, Mothana RA, Noman OM, Tarayrah M, Menana E. QSAR modelling, molecular docking, molecular dynamic and ADMET prediction of pyrrolopyrimidine derivatives as novel Bruton's tyrosine kinase (BTK) inhibitors. Saudi Pharm J 2024; 32:101911. [PMID: 38226346 PMCID: PMC10788635 DOI: 10.1016/j.jsps.2023.101911] [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: 09/08/2023] [Accepted: 12/07/2023] [Indexed: 01/17/2024] Open
Abstract
In recent years, there has been a focus on developing and discovering novel Bruton's tyrosine kinase (BTK) inhibitors, as they offer an effective treatment strategy for B-cell malignancies. BTK plays a crucial role in B cell receptor (BCR)-mediated activation and proliferation by regulating downstream factors such as the NF-κB and MAP kinase pathways. To address this challenge and propose potential therapeutic options for B-cell lymphomas, researchers conducted 2D-QSAR and ADMET studies on pyrrolopyrimidine derivatives that act as inhibitors of the BCR site in cytochrome b. These studies aim to improve and identify new compounds that could serve as more potent potential BTK inhibitors, which would lead to the identification of new drug candidates in this field. In our study, we used 2D-QSAR (multiple linear regression, multiple nonlinear regression, and artificial neural networks), molecular docking, molecular dynamics, and ADMET properties to investigate the potential of 35 pyrrolopyrimidine derivatives as BTK inhibitors. A molecular docking study and molecular dynamics simulations of molecule 13 over 10 ns revealed that it establishes multiple hydrogen bonds with several residues and exhibits frequent stability throughout the simulation period. Based on the results obtained by molecular modeling, we proposed six new compounds (Pred1, Pred2, Pred3, Pred4, Pred5, and Pred6) with highly significant predicted activity by MLR models. A study based on the in silico evaluation of the predicted ADMET properties of the new candidate molecules is strongly recommended to classify these molecules as promising candidates for new anticancer agents specifically designed to target Bruton's tyrosine kinase (BTK) inhibition.
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Affiliation(s)
- Mourad Aloui
- LIMAS Laboratory, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohammed Er-rajy
- LIMAS Laboratory, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hamada Imtara
- Faculty of Sciences, Arab American University Palestine, Jenin 44862, Palestine
| | - Amina Goudzal
- Engineering Laboratory of Organometallic, Molecular Materials and Environment, Sidi Mohamed Ben Abdellah University, Faculty of Sciences, Fez, Morocco
| | - Sara Zarougui
- LIMAS Laboratory, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed El fadili
- LIMAS Laboratory, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - David E. Arthur
- Department of Pure and Applied Chemistry, University of Maiduguri, Nigeria
| | - Ramzi A. Mothana
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Omar M. Noman
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mahmoud Tarayrah
- Groupe Hospitalier Cochin-Port Royal, Faculty of Medicine, Institut Cochin, Paris University, CNRS, IN-SERM, 75000, Paris, France
| | - Elhalaoui Menana
- LIMAS Laboratory, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Collaro AJ, Chalmers JD, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. A core outcome set for bronchiectasis in children and adolescents for use in clinical research: an international consensus study. THE LANCET. RESPIRATORY MEDICINE 2024; 12:78-88. [PMID: 38070531 DOI: 10.1016/s2213-2600(23)00233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 01/06/2024]
Abstract
Improving the treatment of non-cystic fibrosis bronchiectasis in children and adolescents requires high-quality research with outcomes that meet study objectives and are meaningful for patients and their parents and caregivers. In the absence of systematic reviews or agreement on the health outcomes that should be measured in paediatric bronchiectasis, we established an international, multidisciplinary panel of experts to develop a core outcome set (COS) that incorporates patient and parent perspectives. We undertook a systematic review from which a list of 21 outcomes was constructed; these outcomes were used to inform the development of separate surveys for ranking by parents and patients and by health-care professionals. 562 participants (201 parents and patients from 17 countries, 361 health-care professionals from 58 countries) completed the surveys. Following two consensus meetings, agreement was reached on a ten-item COS with five outcomes that were deemed to be essential: quality of life, symptoms, exacerbation frequency, non-scheduled health-care visits, and hospitalisations. Use of this international consensus-based COS will ensure that studies have consistent, patient-focused outcomes, facilitating research worldwide and, in turn, the development of evidence-based guidelines for improved clinical care and outcomes. Further research is needed to develop validated, accessible measurement instruments for several of the outcomes in this COS.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | | | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University of Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Department of Pulmonology, Children's Hospital, Winterthur, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- Pulmonology Department, National Pirogov Medical University, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Marijke Proesmans
- Pediatric Pulmonology, Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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6
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Song G, Zhang Y, Yu S, Sun M, Zhang B, Peng M, Lv W, Zhou H. Efficacy and safety of macrolides in the treatment of children with bronchiectasis: a meta-analysis. Pediatr Res 2023; 94:1600-1608. [PMID: 37237074 DOI: 10.1038/s41390-023-02591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study summarized the available randomized controlled trials (RCTs) to assess the efficacy and safety of macrolides on pathogens, lung function, laboratory parameters, and safety in children with bronchiectasis. METHODS PubMed, EMBASE, and the Cochrane Library were searched for available papers published up to June 2021. The outcomes were the pathogens, adverse events (AEs), and the forced expiratory volume in one second (FEV1%) predicted. RESULTS Seven RCTs (633 participants) were included. The long-term use of macrolides reduced the risk of the presence of Moraxella catarrhalis (RR = 0.67, 95% CI: 0.30-1.50, P = 0.001; I2 = 0.0%, Pheterogeneity = 0.433), but not Haemophilus influenza (RR = 0.19, 95% CI: 0.08-0.49, P = 0.333; I2 = 57.0%, Pheterogeneity = 0.040), Streptococcus pneumonia (RR = 0.91, 95% CI: 0.61-1.35, P = 0.635; I2 = 0.0%, Pheterogeneity = 0.515), Staphylococcus aureus (RR = 1.01, 95% CI: 0.36-2.84, P = 0.986; I2 = 61.9%, Pheterogeneity = 0.033), and any pathogens present (RR = 0.61, 95% CI: 0.29-1.29, P = 0.195; I2 = 80.3%, Pheterogeneity = 0.006). Long-term macrolides had no effect on FEV1% predicted (WMD = 2.61, 95% CI: -1.31, 6.53, P = 0.192; I2 = 0.0%, Pheterogeneity = 0.896). Long-term macrolides did not increase the risk of AEs or serious AEs. CONCLUSION Macrolides do not significantly reduce the risk of pathogens present (except for Moraxella catarrhalis) or increase FEV1% predicted among children with bronchiectasis. Moreover, macrolides were not associated with AEs. Considering the limitations of the meta-analysis, further larger-scale RCTs are needed to confirm the findings. IMPACT Macrolides do not significantly reduce the risk of pathogens present (except for Moraxella catarrhalis) among children with bronchiectasis. Macrolides do not significantly increase FEV1% predicted among children with bronchiectasis. This meta-analysis reports on the efficacy and safety of macrolides in the treatment of children with bronchiectasis, providing evidence for the management of children with bronchiectasis. This meta-analysis does not support the use of macrolides in the management of children with bronchiectasis unless the presence of Moraxella catarrhalis is provenor suspected.
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Affiliation(s)
- Guihua Song
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China.
| | - Yan Zhang
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Suping Yu
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Mengmeng Sun
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Bingxue Zhang
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Minghao Peng
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Weigang Lv
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
| | - Hongyun Zhou
- Department of Pediatric, The First Affiliated Hospital of Henan University of TCM, 19 Renmin Road, Jinshui District, 450000, Zhengzhou, China
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7
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Welford A, McCallum GB, Hodson M, Johnston H. Physiotherapy management of first nations children with bronchiectasis from remote top end communities of the northern territory: a retrospective chart audit. Front Pediatr 2023; 11:1230474. [PMID: 37900672 PMCID: PMC10613054 DOI: 10.3389/fped.2023.1230474] [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: 05/29/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Background Bronchiectasis is a chronic pulmonary disorder which is prevalent among Australian First Nations people in the Northern Territory (NT). Current guidelines recommend physiotherapy as part of multi-disciplinary management of children with bronchiectasis, however in our setting, involvement of physiotherapy remains unknown. We thus undertook a retrospective chart audit to examine physiotherapy management of First Nations children (<18 years) from remote First Nations communities in the Top End of the NT at the index bronchiectasis diagnosis and 12 months following diagnosis. Methods Participants were identified from a larger prospective study of children investigated for bronchiectasis at Royal Darwin Hospital, NT (2007-2016). Children were included if they were First Nations, aged <18 years, had a radiological diagnosis of bronchiectasis on high resolution computed tomography scan and lived in a remote community serviced by NT Government health clinics. The medical records from NT Government hospitals, health clinics and where possible other medical service attendance were reviewed for physiotherapy referral and management at the time of bronchiectasis diagnosis and in the following 12 months in the community. Results Of 143 children included, the mean age was 3.1 (standard deviation 2.4) years and 84 (58.7%) were males. At the index diagnosis, 76/122 (62.3%) children were reviewed by a physiotherapist, consisting of airway clearance techniques (83.8%), physical activity/exercise (81.7%) and caregiver education (83.3%), with only 7/127 (5.5%) having evidence of referral for community-based physiotherapy. In the following 12 months, only 11/143 (7.7%) children were reviewed by a physiotherapist, consisting of airway clearance techniques (54.5%), physical activity/exercise (45.5%) and caregiver education (36.4%). Conclusion This study demonstrates a significant gap in the provision of physiotherapy services in our setting and the need to develop a standardized pathway, to support the best practice management of children with bronchiectasis in remote Top End communities of the NT.
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Affiliation(s)
- A Welford
- Community Allied Health Team, Top End Population and Primary Healthcare, NT Health, Darwin, NT, Australia
| | - GB McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - M Hodson
- Community Allied Health Team, Top End Population and Primary Healthcare, NT Health, Darwin, NT, Australia
| | - H Johnston
- Community Allied Health Team, Top End Population and Primary Healthcare, NT Health, Darwin, NT, Australia
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Wang H, Xu B, Bao Y, Yang Y, Qian L, Zhang H, Zhu C, Yin Y, Jiang M, Dai J, Xu Y, Zhu X, Zhu X, Shen K. Etiology and clinical features of children with bronchiectasis in China: A 10-year multicenter retrospective study. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:841-850. [PMID: 37259267 PMCID: PMC10500320 DOI: 10.1111/crj.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The current study aims to investigate the etiology spectrum and the clinical characteristics of bronchiectasis in Chinese children. METHODS The study is designed as a multicenter retrospective study. 193 cases were enrolled in 13 centers in China between 2008 and 2017. The inclusive cases must meet the clinical as well as the HRCT criteria. Only if both two radiologists confirmed the diagnosis, the case could be enrolled. The cases that could not provide clinical and imageology data were excluded. The data were entered into the specialized system and then analyzed. RESULTS One hundred sixty-nine cases (87%) were found to have the underlying etiology. Post-infective (46%), primary immunodeficiency (14%), and PCD (13%) were the common causes. All cases came from 28 provinces in Mainland China. The median age of symptom onset was 5.8 (2.0, 8.9) years. The median age of diagnosis was 8.4 (4.5, 11.6) years. The main symptoms were cough, sputum expectoration, and fever during the exacerbation. Nineteen percent of patients suffered from limited exercise tolerance. Clubbing was found in 17% of cases. Nearly 30% of patients presented growth limitations. On the HRCT findings, 126 cases had diffused bronchiectasis, and bilateral involvement was found in 94 cases. The lower lobes and right middle lobes were most commonly involved. Approximately 30% of cultures of sputum and bronchoalveolar lavage were positive. CONCLUSION A majority of cases could be found the underlying etiology. Post-infective, primary immunodeficiency, and PCD were the most common causes. Some clinical figures might indicate a specific etiology.
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Affiliation(s)
- Hao Wang
- Beijing Children's HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Bao‐ping Xu
- Beijing Children's HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Respiratory DiseasesBeijingChina
| | - Yan‐min Bao
- Shenzhen Children's HospitalShenzhenGuangzhouChina
| | - Yungang Yang
- The first affiliated hospital of Xiamen UniversityXiamenFujianChina
| | - Li‐ling Qian
- Children's Hospital of Fudan UniversityShanghaiChina
| | - Hai‐lin Zhang
- The 2nd Affiliated Hospital and Yuying Children's Hospital of WMUWenzhouZhejiangChina
| | - Chun‐mei Zhu
- Capital Institute of PediatricsChildren's HospitalBeijingChina
| | - Yong Yin
- Shanghai Children's Medical CenterShanghaiChina
| | - Min Jiang
- The First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxiChina
| | - Ji‐hong Dai
- Children's Hospital of Chongqing Medical UniversityChongqingChina
| | | | - Xiao‐hua Zhu
- Jiangxi Provincial Children's HospitalNanchangJiangxiChina
| | - Xiao‐ping Zhu
- The Affiliated Hospital of Guizhou Medical UniversityGuiyangGuizhouChina
| | - Kun‐ling Shen
- Beijing Children's HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Respiratory DiseasesBeijingChina
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9
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Singhal KK, Singh R. Chronic Suppurative Lung Disease in Children: A Case Based Approach. Indian J Pediatr 2023; 90:920-926. [PMID: 37389774 DOI: 10.1007/s12098-023-04665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
Bronchiectasis is a pathologic state of conducting airways manifested radiographically by evidence of bronchial dilation and clinically by chronic productive cough. Considered an "orphan disease" for long, it remains a major contributor to morbidity and mortality in both developed and underdeveloped countries. With the advances in the medical field accompanied by widespread access to vaccines and antibiotics, improved health services and better access to nutrition, the incidences of bronchiectasis have markedly decreased, particularly in developed countries. This review summarizes the current knowledge pertaining to the clinical definition, etiology, clinical approach and management related to pediatric bronchiectasis.
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Affiliation(s)
- Kamal Kumar Singhal
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India.
| | - Robin Singh
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India
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10
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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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11
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Chang AB, Bell SC, Byrnes CA, Dawkins P, Holland AE, Kennedy E, King PT, Laird P, Mooney S, Morgan L, Parsons M, Poot B, Toombs M, Torzillo PJ, Grimwood K. Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand. Respirology 2023; 28:339-349. [PMID: 36863703 PMCID: PMC10947421 DOI: 10.1111/resp.14479] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Abstract
This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Scott C. Bell
- Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Translational Research InstituteBrisbaneQueenslandAustralia
| | - Catherine A. Byrnes
- Department of PaediatricsUniversity of AucklandAucklandNew Zealand
- Starship Children's HospitalAucklandNew Zealand
| | - Paul Dawkins
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Anne E. Holland
- Department of PhysiotherapyAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Institute for Breathing and SleepHeidelbergVictoriaAustralia
| | - Emma Kennedy
- College of Medicine and Public HealthFlinders UniversityDarwinNorthern TerritoryAustralia
- Board of Northern Territory General Practice Education LtdDarwinNorthern TerritoryAustralia
- Pandanus Medical NTMillnerNorthern TerritoryAustralia
| | - Paul T. King
- Departments of Respiratory and Sleep Medicine and Medicine, Monash Medical CentreMonash UniversityMelbourneVictoriaAustralia
| | - Pamela Laird
- Department PhysiotherapyPerth Children's HospitalPerthWestern AustraliaAustralia
- Wal‐yan Respiratory Research CentreTelethon Kids InstitutePerthWestern AustraliaAustralia
- Department of Paediatrics, School of MedicineUniversity of WAPerthWestern AustraliaAustralia
| | - Sarah Mooney
- Department of Respiratory MedicineMiddlemore HospitalAucklandNew Zealand
- School of Clinical SciencesAUT UniversityAucklandNew Zealand
| | - Lucy Morgan
- Department of Respiratory Medicine at Concord and Nepean HospitalsSchool of Medicine, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Marianne Parsons
- Representative of Parent Advisory Group, NHMRC Centre of Research Excellence in Paediatric Bronchiectasis, Cough and Airways Research Group, Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Betty Poot
- Respiratory DepartmentHutt Hospital, Te Whatu Ora Capital, Coast and Hutt ValleyLower HuttNew Zealand
- School of Nursing Midwifery, and Health PracticeVictoria University of WellingtonWellingtonNew Zealand
| | - Maree Toombs
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Paul J. Torzillo
- Nganampa Health CouncilAlice SpringsNorthwest TerritoriesAustralia
- Royal Prince Alfred HospitalUniversity of SydneySydneyNew South WalesAustralia
| | - Keith Grimwood
- School of Medicine and Dentistry, Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
- Departments of Infectious Diseases and PaediatricsGold Coast HealthSouthportQueenslandAustralia
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Gong T, Wang X, Li S, Zhong L, Zhu L, Luo T, Tian D. Global research status and trends of bronchiectasis in children from 2003 to 2022: A 20-year bibliometric analysis. Front Pediatr 2023; 11:1095452. [PMID: 36816374 PMCID: PMC9936077 DOI: 10.3389/fped.2023.1095452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aims to analyze the research hotspots, evolution, and developing trends in pediatric bronchiectasis over the past 20 years using bibliometric analysis and visualization tools to identify potential new research directions. Methods Publications related to bronchiectasis in children were retrieved from the Web of Science Core Collection (WoSCC) database from 2003 to 2022. Knowledge maps were performed through VOSviewer1.6.18 and CiteSpace6.1 R2. Results A total of 2,133 publications were searched, while only 1,351 original articles written in English between 2003 and 2022 were incorporated. After removing duplicates, we finally included 1,350 articles published by 6,593 authors from 1,865 institutions in 80 countries/regions in 384 different academic journals with an average citation frequency of 24.91 times. The number of publications shows an extremely obvious binomial growth trend. The majority of publications originated from the United States, Australia, and England. The institutes in Australia, especially Charles Darwin University, published the most articles associated with pediatric bronchiectasis. In addition, Pediatric Pulmonology was the most published journal. In terms of authors, Chang AB was the most productive author, while Gangell CL had the highest average citation frequency. The five keywords that have appeared most frequently during the last two decades were "children," "cystic fibrosis," "bronchiectasis," "ct," and "pulmonary-function." According to keyword analysis, early diagnosis and intervention and optimal long-term pediatric-specific management were the most concerned topics for researchers. Conclusion This bibliometric analysis indicates that bronchiectasis in children has drawn increasing attention in the last two decades as its recognition continues to rise, providing scholars in the field with significant information on current topical issues and research frontiers.
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Affiliation(s)
| | | | | | | | | | | | - Daiyin Tian
- Department of Respiratory Disease, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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13
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Surgical treatment of bronchiectasis in children: An 11-year experience at a central health facility in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i3.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background. The surgical management of children with bronchiectasis has seldom been reported.Objective. To describe the presentation, surgical management and outcomes in children with bronchiectasis presenting for surgery. Methods. We retrospectively reviewed the electronic records of 0 - 13-year-old children who underwent pulmonary resection for bronchiectasis at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, between January 2004 and December 2014. Clinical, radiological and preoperative bronchoscopic findings, as well as surgical and histological outcomes, were analysed.Results. Eighty-eight patients underwent surgical resection. The female/male ratio was 3:2, with a mean age at surgery of 8.2 (range 2 - 13) years; 39 patients were HIV infected and 39 were HIV uninfected. Tuberculosis (TB) (n=68; 77.2%) was the most common cause of bronchiectasis, and recurrent chest infection (n= 45; 51.1%) was the most common clinical finding. Radiological examination confirmed isolated left-sided disease in 40 children (45.4%), isolated right-sided disease in 28 (31.8%) and bilateral disease in 20 (22.7%). Saccular disease with fibrocavitation (n=35; 39.7%) was the most common morphological disease type. Preoperative bronchoalveolar lavage samples confirmed a bacterial cause in 27 patients (30.6%). The most common operative procedures were primary pneumonectomy in 33 patients (37.0%), lobectomy in 30 (34.0%) and bilobectomy in 13 (14.7%). Seventy-five patients were asymptomatic after the operation and complications occurred in 13. Two children (2.2%), one with sepsis and the other with intraoperative hypoxia, died. Seventy patients underwent complete resection. At 1 month after surgery, 89.2% of patients were asymptomatic, while 77.7% of symptomatic patients were HIV positive.Conclusions. Complete pulmonary resection in children with advanced-stage bronchiectasis is safe, with a low morbidity and mortality. Surgery in HIV-positive patients was not associated with worse outcomes and is not contraindicated. HIV- and TB-preventive measures could reduce the burden of childhood bronchiectasis.
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Gallucci M, Candela E, Di Palmo E, Miniaci A, Pession A. Non-Cystic Fibrosis Bronchiectasis in Pediatric Age: A Case Series in a Metropolitan Area of Northern Italy. CHILDREN 2022; 9:children9091420. [PMID: 36138729 PMCID: PMC9497485 DOI: 10.3390/children9091420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 09/17/2022] [Indexed: 11/24/2022]
Abstract
Non-cystic fibrosis bronchiectasis is an emergent disease characterized by endobronchial suppuration, dilated airways with neutrophilic inflammation and chronic wet cough due to recurrent lower airway infections. A regular clinical follow-up and adequate management of exacerbations are essential to reduce symptoms and the worsening of lung injury. We report a retrospective study comprising 15 children and adolescents with NCFB followed in our hospital center of pediatric pulmonology. We retrospectively analyzed the main comorbidities associated with the presence of NCFB, the radiological aspect associated with the different etiologies and the therapeutic approach used. We also emphasized the importance of an effective preventive strategy to reduce and prevent pulmonary exacerbations.
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Affiliation(s)
- Marcella Gallucci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Egidio Candela
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Correspondence: or ; Tel.: +39-3473878582
| | - Emanuela Di Palmo
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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15
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Caglar Tosun BN, Zeren M, Barlik M, Demir E, Gulen F. Investigation of dynamic hyperinflation and its relationship with exercise capacity in children with bronchiectasis. Pediatr Pulmonol 2022; 57:2218-2226. [PMID: 35666051 DOI: 10.1002/ppul.26028] [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: 03/09/2022] [Revised: 05/07/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM Dynamic hyperinflation (DH) is a major contributor to exercise intolerance in patients with obstructive lung diseases. However, it has not been investigated in children with bronchiectasis (BE). We aimed to investigate dynamic ventilatory responses and their influence on functional exercise capacity in children with BE. METHODS Forty children with BE (mean forced expiratory volume in 1 s [FEV1 ] = 78 ± 19%pred) were included. Six-minute walk test (6MWT) was conducted using Spiropalm 6MWT® for evaluating dynamic ventilatory responses including inspiratory capacity (IC), minute ventilation (VE), breathing reserve (BR) and respiratory rate (RR). A decrease of ≥100 ml in IC during exertion was defined as DH. Also, spirometry was performed, and peripheral muscle strength were measured. RESULTS Twenty patients (50%) developed DH, and four patients (10%) were ventilatory limited (BR < %30) during 6MWT. There was a 176 [100-590] ml decrease in IC after exertion in patients with DH. DH did not correlate to clinical or functional indicators of the disease, except for an increase in RR (∆RR) during exertion. High ∆RR was associated with presence of DH (rpb = 0.390; p < 0.05). Clinical features, peripheral muscle strength, and Spiropalm 6MWT metrics including 6MWT distance did not differ between patients with and without DH. Univariate analysis revealed FVC% (R = 0.340), VEpeak (R = 0.565), quadriceps strength (R = 0.698) and handgrip strength (R = 0.711) were the only predictors of 6MWT distance (p < 0.05). CONCLUSION Although DH is common in children with BE, the severity of DH is rather low and may not seem to affect functional exercise capacity. However, peripheral muscle strength was a major contributor to functional exercise capacity.
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Affiliation(s)
- Beyza Nur Caglar Tosun
- Department of Physiotherapy and Rehabilitation, Graduate Education Institute, Izmir Bakircay University, Izmir, Turkey
| | - Melih Zeren
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Meral Barlik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Esen Demir
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Gulen
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. Quality standards for managing children and adolescents with bronchiectasis: an international consensus. Breathe (Sheff) 2022; 18:220144. [PMID: 36865655 PMCID: PMC9973502 DOI: 10.1183/20734735.0144-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients' survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia,Corresponding author: Anne B. Chang ()
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T. Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D. Chalmers
- College of Medicine, University of Dundee, Dundee, UK,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J. Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine,Vinnytsya Children's Regional Hospital, Pulmonology Dept, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy,Both authors contributed equally to this article as senior authors
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia,Both authors contributed equally to this article as senior authors
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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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18
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. International consensus statement on quality standards for managing children/adolescents with bronchiectasis from the ERS CRC Child-BEAR-Net. Eur Respir J 2022; 59:59/6/2200264. [PMID: 35680151 DOI: 10.1183/13993003.00264-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
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.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group
| | - Angela Zacharasiewicz
- Dept of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D Chalmers
- College of Medicine, University of Dundee, Dundee, UK.,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Dept of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Dept of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine.,Pulmonology Dept, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy.,Co-senior author
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Depts of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia.,Co-senior author
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19
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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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20
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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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21
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The Spectrum of Airway Involvement in Inflammatory Bowel Disease. Clin Chest Med 2022; 43:141-155. [DOI: 10.1016/j.ccm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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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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23
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Long-term, low-dose macrolide antibiotic treatment in pediatric chronic airway diseases. Pediatr Res 2022; 91:1036-1042. [PMID: 34120139 PMCID: PMC9122820 DOI: 10.1038/s41390-021-01613-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
Macrolide antibiotics are one of the most commonly used broad-spectrum antibiotics. They have an inhibitory effect on a variety of respiratory pathogens; besides, they have non-anti-infective effects, including anti-inflammatory, regulating airway secretion, immune regulation, and other effects. A growing number of studies have shown that the non-anti-infective effects of macrolides have important and potential value in the treatment of pediatric chronic airway diseases; the therapy was described as "long-term, low-dose usage"; unfortunately, there is no guideline or consensus that applies to children. To better carry out the mechanism and clinical research of non-anti-infective effect and promote its rational use in children, the authors summarize the evidence of the usage of long-term, low-dose macrolide antibiotic therapy (LLMAT) in the treatment of chronic airway diseases in children and the progress in recent years. IMPACT: This review summarizes the evidence (mostly in recent 5 years) of the usage of long-term, low-dose macrolide antibiotic therapy in the treatment of chronic airway diseases. The recent studies and guidelines support and enrich the point that long-term, low-dose macrolide antibiotic therapy has potential benefit for children with severe asthma, CF, non-CF bronchiectasis, and BO, which provides clinical references and is of clinical interest. Long-term, low-dose macrolide antibiotic therapy has good safety, and no serious events have been reported; however, potential cardiac side effects and macrolide resistance should be clinically noted.
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24
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Naranje P, Shera T, Bhalla A, Meena P, Kabra S, Gupta A, Kandasamy D. Role of computed tomography angiography in the evaluation of haemoptysis in children: Decoding the abnormal vessels. Indian J Med Res 2022; 155:356-363. [DOI: 10.4103/ijmr.ijmr_3271_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Verwey C, Gray DM, Dangor Z, Ferrand RA, Ayuk AC, Marangu D, Kwarteng Owusu S, Mapani MK, Goga A, Masekela R. Bronchiectasis in African children: Challenges and barriers to care. Front Pediatr 2022; 10:954608. [PMID: 35958169 PMCID: PMC9357921 DOI: 10.3389/fped.2022.954608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.
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Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross Warm Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.,The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Adaeze C Ayuk
- Department of Pediatrics, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Sandra Kwarteng Owusu
- Department of Child Health, School of Medicine and Dentistry, Komfo Anokje Teaching Hospital, Kwane Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Johannesburg, South Africa.,Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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26
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Marchant JM, Chang AB, Schutz KL, Versteegh L, Cook A, Roberts J, Morris PS, Yerkovich ST, McCallum GB. Utility of a personalised Bronchiectasis Action Management Plan (BAMP) for children with bronchiectasis: protocol for a multicentre, double-blind parallel, superiority randomised controlled trial. BMJ Open 2021; 11:e049007. [PMID: 34937712 PMCID: PMC8704965 DOI: 10.1136/bmjopen-2021-049007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Bronchiectasis is no longer considered rare or irreversible in children, yet it remains relatively under-researched and neglected in respiratory health globally. Bronchiectasis (including chronic suppurative lung disease) causes substantial morbidity for patients and significant impact on caregivers, especially during acute respiratory exacerbations. In other chronic respiratory diseases (eg, asthma), empowering consumers with an individualised plan for management of acute exacerbations improves clinical outcomes. However, in the absence of any such data specific to bronchiectasis, action management plans are rarely currently used in children or adults with bronchiectasis. We hypothesise that providing an individualised bronchiectasis action management plan (BAMP) to children with bronchiectasis reduces non-scheduled doctor consultations, compared with not having a BAMP. METHODS AND ANALYSIS This multicentre, parallel, double-blind, randomised trial involving three urban Australian hospitals commenced in June 2018 and will include 198 children, aged <19 years with bronchiectasis who had 2 or more exacerbations in the previous 18 months. Children will be randomised to having an individualised BAMP or standard care (a decoy clinic letter). Primary caregivers will then be followed up monthly for 12 months. The primary outcome is the rate of acute non-scheduled doctor visits for respiratory exacerbations by 12 months. The main secondary outcomes are cough-specific quality of life scores at 6 and 12 months, overall exacerbation rate over 12 months, and proportion of children who received timely influenza vaccination by 30 May annually. ETHICS AND DISSEMINATION The Human Research Ethics Committees of the Northern Territory Department of Health and Menzies School of Heath Research and Queensland Children's Hospital approved the study. The results of the trial will be submitted for publication and the BAMP made available free online. TRIAL REGISTRATION NUMBER Australia and New Zealand Clinical Trials Register ACTRN12618000604202.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kobi L Schutz
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lesley Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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27
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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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28
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Cheng ZR, Chua YX, How CH, Tan YH. Approach to chronic cough in children. Singapore Med J 2021; 62:513-519. [DOI: 10.11622/smedj.2021200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Kapur N, Stroil-Salama E, Morgan L, Yerkovich S, Holmes-Liew CL, King P, Middleton P, Maguire G, Smith D, Thomson R, McCallum G, Owens L, Chang AB. Factors associated with "Frequent Exacerbator" phenotype in children with bronchiectasis: The first report on children from the Australian Bronchiectasis Registry. Respir Med 2021; 188:106627. [PMID: 34592538 DOI: 10.1016/j.rmed.2021.106627] [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: 07/26/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In adults with bronchiectasis, multicentre data advanced the field including disease characterisation and derivation of phenotypes such as 'frequent exacerbator (FE)' (≥3 exacerbations/year). However, paediatric cohorts are largely limited to single centres and no scientifically derived phenotypes of paediatric bronchiectasis yet exists. Using paediatric data from the Australian Bronchiectasis Registry (ABR), we aimed to: (a) describe the clinical characteristics and compare Indigenous with non-Indigenous children, and (b) determine if a FE phenotype can be identified and if so, its associated factors. METHODS We retrieved data of children (aged <18-years) with radiologically confirmed bronchiectasis, enrolled between March 2016-March 2020. RESULTS Across five sites, 540 children [288 Indigenous; median age = 8-years (IQR 6-11)] were included. Baseline characteristics revealed past infection/idiopathic was the commonest (70%) underlying aetiology, most had cylindrical bronchiectasis and normal spirometry. Indigenous children (vs. non-Indigenous) had significantly more environmental tobacco smoke exposure (84% vs 32%, p < 0.0001) and lower birth weight (2797 g vs 3260 g, p < 0.0001). FE phenotype present in 162 (30%) children, was associated with being younger (ORadjusted = 0.85, 95%CI 0.81-0.90), more recent diagnosis of bronchiectasis (ORadjusted = 0.67; 95%CI 0.60-0.75), recent hospitalization (ORadj = 4.51; 95%CI 2.45-8.54) and Pseudomonas aeruginosa (PsA) infection (ORadjusted = 2.43; 95%CI 1.01-5.78). The FE phenotype were less likely to be Indigenous (ORadjusted = 0.14; 95%CI 0.03-0.65). CONCLUSION Even within a single country, the characteristics of children with bronchiectasis differ among cohorts. A paediatric FE phenotype exists and is characterised by being younger with a more recent diagnosis, PsA infection and previous hospitalization. Prospective data to consolidate our findings characterising childhood bronchiectasis phenotypes are required.
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Affiliation(s)
- Nitin Kapur
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, QLD, Australia.
| | | | - Lucy Morgan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Stephanie Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Australia
| | - Chien-Li Holmes-Liew
- Department of Thoracic Medicine, Royal Adelaide Hospital, South Australia, Australia
| | - Paul King
- Monash Respiratory and Sleep Medicine, Monash Medical Centre, VIC, Australia
| | - Peter Middleton
- Department of Respiratory & Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Graeme Maguire
- Western Clinical School, University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Smith
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rachel Thomson
- Department of Respiratory Medicine, Greenslopes Private Hospital and Gallipoli Medical Research Institute, University of Queensland, Greenslopes, QLD, Australia
| | - Gabrielle McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louisa Owens
- Department of Respiratory Medicine, Sydney Children's Hospital, NSW, Australia
| | - Anne B Chang
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Australia
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Ullmann N, Porcaro F, Petreschi F, Cammerata M, Allegorico A, Negro V, Cutrera R. Noncystic fibrosis bronchiectasis in children and adolescents: Follow-up over a decade. Pediatr Pulmonol 2021; 56:3026-3034. [PMID: 34265867 DOI: 10.1002/ppul.25553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Noncystic fibrosis bronchiectasis (NCFB) is still considered an "orphan disease" in pediatric age. OBJECTIVE The study describes the clinical and functional features, the instrumental, and microbial findings of a large cohort of patients with NCFB, followed in a single tertiary level hospital. METHODS Children and adolescents diagnosed with NCFB from January 1, 2010 to December 31, 2019 were included. Data from the diagnosis and during the years of follow-up were recorded retrospectively. RESULTS One hundred and thirty-eight patients were enrolled. The most common cause of NCFB was postinfectious (33%), followed by primary ciliary dyskinesia (PCD) (30%), esophageal atresia (EA) (9.5%), and secondary immunodeficiency (9.5%). Chronic cough was the most frequent symptom. The median age of symptoms presentation was 3 years (interquartile age [IQR]: 12-84), with a precocious onset in PCD and EA groups. The median age of CT diagnosis was 9 years for all groups but PCD patients who were diagnosed at older age. Lingula, medium, upper, and lower lobes were more involved in PCD group, while diffuse distribution was observed in the postinfectious one. Microbial exams showed Pseudomonas aeruginosa colonization higher in PCD patients (22%). Despite microbial differences in airways colonization, no difference in respiratory exacerbation rate was recorded among groups. Lung function tests demonstrated the stability of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) over time, except for the secondary immunodeficiency group. CONCLUSIONS The role of infections in developed countries should not be underestimated and a major effort to obtain an earlier identification of bronchiectasis should be taken. A prompt diagnosis of NFCB could help to reduce the frequency of exacerbations and improve the stability of lung function over time.
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Affiliation(s)
- Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Petreschi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Cammerata
- Academic Department of Pediatrics, Tor Vergata University, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Negro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Durand M, Musleh L, Vatta F, Orofino G, Querciagrossa S, Jugie M, Bustarret O, Delacourt C, Sarnacki S, Blanc T, Khen-Dunlop N. Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology. J Pediatr Surg 2021; 56:1606-1610. [PMID: 33250217 DOI: 10.1016/j.jpedsurg.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/31/2020] [Accepted: 11/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/PURPOSE Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis. METHODS Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014-2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California). RESULTS Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication. CONCLUSIONS Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection - useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.
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Affiliation(s)
- Marion Durand
- Ramsay Générale de Santé, Hôpital Privé d'Antony, Antony, France
| | - Layla Musleh
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France
| | - Fabrizio Vatta
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Giorgia Orofino
- Département d'Anesthésie Hôpital Necker-Enfants Malades, Paris, France
| | | | - Myriam Jugie
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Bustarret
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Thomas Blanc
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Naziha Khen-Dunlop
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France.
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Prime SJ, Carter HE, McPhail SM, Petsky HL, Chang AB, Graves N, Marchant JM. Chronic wet cough in Australian children: Societal costs and quality of life. Pediatr Pulmonol 2021; 56:2707-2716. [PMID: 33939893 DOI: 10.1002/ppul.25438] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children with chronic wet cough regularly use the health system, experience considerable variability in care, have reduced quality of life (QoL), and, left untreated, poorer health outcomes. Despite this, little is known about the associated economic burden. This study aimed to quantify the cost of chronic wet cough among Australian children from the perspectives of families and the health system. METHODS A cost of illness study was conducted at the Queensland Children's Hospital, Brisbane, using data on 91 children newly referred to a respiratory specialist between July 2015 and January 2017 with a history of chronic wet cough (>4 weeks) of unknown etiology. Administrative and parent-reported data were used to estimate costs (reported in 2019 Australian Dollars [AUD]) for up to 12 months before and following initial pulmonology consultation. QoL was assessed for the same periods. RESULTS Mean cost per child-month during the average 9.8 months of observation preceding pulmonology consultation was AUD689 (95% confidence interval [CI] 534-844) increasing to AUD1339 (95% CI 1051-1628) during the average 11.9 months following pulmonology consultation. This translated to a total of AUD1.9 million across the study period, with families bearing 26.4% of costs. Aspiration and bronchiectasis were associated with higher total costs. For all etiologies, cough-specific QoL improved following pulmonology consultation, while direct medical costs declined. CONCLUSION Childhood chronic wet cough is associated with substantial societal costs. The observed cost decrease after specialist diagnosis suggests that early referral to a respiratory specialist may have economic benefits, in addition to the known health benefits.
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Affiliation(s)
- Samantha J Prime
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University and Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Nicholas Graves
- Health Service and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Julie M Marchant
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Chang AB, Boyd J, Bell L, Goyal V, Masters IB, Powell Z, Wilson C, Zacharasiewicz A, Alexopoulou E, Bush A, Chalmers JD, Fortescue R, Hill AT, Karadag B, Midulla F, McCallum GB, Snijders D, Song WJ, Tonia T, Grimwood K, Kantar A. Clinical and research priorities for children and young people with bronchiectasis: an international roadmap. ERJ Open Res 2021; 7:00122-2021. [PMID: 34291113 PMCID: PMC8287136 DOI: 10.1183/23120541.00122-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
The global burden of children and young people (CYP) with bronchiectasis is being recognised increasingly. They experience a poor quality of life and recurrent respiratory exacerbations requiring additional treatment, including hospitalisation. However, there are no published data on patient-driven clinical needs and/or research priorities for paediatric bronchiectasis. Parent/patient-driven views are required to understand the clinical needs and research priorities to inform changes that benefit CYP with bronchiectasis and reduce their disease burden. The European Lung Foundation and the European Respiratory Society Task Force for paediatric bronchiectasis created an international roadmap of clinical and research priorities to guide, and as an extension of, the clinical practice guideline. This roadmap was based on two global web-based surveys. The first survey (10 languages) was completed by 225 respondents (parents of CYP with bronchiectasis and adults with bronchiectasis diagnosed in childhood) from 21 countries. The parent/patient survey encompassed both clinical and research priorities. The second survey, completed by 258 health practitioners from 54 countries, was limited to research priorities. The two highest clinical needs expressed by parents/patients were: having an action management plan for flare-ups/exacerbations and access to physiotherapists. The two highest health practitioners’ research priorities related to eradication of airway pathogens and optimal airway clearance techniques. Based on both surveys, the top 10 research priorities were derived, and unanimous consensus statements were formulated from these priorities. This document addresses parents'/patients' clinical and research priorities from both the parents'/patients' and clinicians' perspectives and will help guide research and clinical efforts to improve the lives of people with bronchiectasis. This document is an international roadmap on parents’/patients’ clinical and research priorities from both the parents’/patients’ and clinicians’ perspectives to help guide research and clinical efforts to improve the lives of people with bronchiectasishttps://bit.ly/3xoonwi
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Leanne Bell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - I Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Dept of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew Bush
- Dept 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
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, 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
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,These authors contributed equally as senior authors
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro, Bergamo, Italy.,These authors contributed equally as senior authors
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McCallum GB, Oguoma VM, Versteegh LA, Wilson CA, Bauert P, Spain B, Chang AB. Comparison of Profiles of First Nations and Non-First Nations Children With Bronchiectasis Over Two 5-Year Periods in the Northern Territory, Australia. Chest 2021; 160:1200-1210. [PMID: 33964302 DOI: 10.1016/j.chest.2021.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the burden of bronchiectasis is recognized globally, pediatric data are limited, particularly on trends over the years. Also, no published data exists regarding whether vitamin D deficiency or insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to be related to severe bronchiectasis in First Nations adults, also are important in children with bronchiectasis. RESEARCH QUESTION Among children with bronchiectasis, (1) have the clinical and BAL profiles changed between two 5-year periods (period 1, 2007-2011; period 2, 2012-2016) and (b) are vitamin D deficiency or insufficiency, HTLV-1 infection, or both associated with radiologic severity of bronchiectasis? STUDY DESIGN AND METHODS We analyzed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia, at the first diagnosis; that is, no child was included in both periods. Data collected include demographics, BAL, bloods, and high-resolution CT scan of the chest evaluated using the Bhalla and modified Bhalla scores. RESULTS The median age of the 299 children was 2.2 years (interquartile range, 1.5-3.7 years). One hundred sixty-eight (56%) were male and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations children more than tripled, but did not reach statistical significance. In period 2 compared with period 1, fewer First Nations children demonstrated chronic cough (period 1, 61%; period 2, 47%; P = .03), were younger, First Nations children were less likely to have received azithromycin (period 1, 42%; period 2, 21%; P < .001), and the BAL fluid of First Nations children showed lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 infection was not detected, and vitamin D deficiency or insufficiency did not correlate with severity of bronchiectasis. INTERPRETATION Bronchiectasis remains high particularly among First Nations children. Important changes in their profiles that arguably reflect improvements were present, but overall, the profiles remained similar. Although vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 infection was nonexistent and is unlikely to play any role in First Nations children with bronchiectasis.
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Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Health Research Institute, University of Canberra, Canberra, ACT
| | - Lesley A Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Cate A Wilson
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Paul Bauert
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT
| | - Brian Spain
- Department of Anaesthetics, Royal Darwin Hospital, Darwin, NT
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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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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Dangor Z, Verwey C, Lala SG, Mabaso T, Mopeli K, Parris D, Gray DM, Chang AB, Zar HJ. Lower Respiratory Tract Infection in Children: When Are Further Investigations Warranted? Front Pediatr 2021; 9:708100. [PMID: 34395346 PMCID: PMC8356913 DOI: 10.3389/fped.2021.708100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Theodore Mabaso
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Keketso Mopeli
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Parris
- Department of Paeditrics, University of Pretoria, Pretoria, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Sibanda D, Singleton R, Clark J, Desnoyers C, Hodges E, Day G, Redding G. Adult outcomes of childhood bronchiectasis. Int J Circumpolar Health 2020; 79:1731059. [PMID: 32090714 PMCID: PMC7048197 DOI: 10.1080/22423982.2020.1731059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20-40 years of age from Alaska's Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.
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Affiliation(s)
- Dawn Sibanda
- Research Department, Yukon Kuskokwim Health Corporation, Bethel, AK, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rosalyn Singleton
- Research Department, Yukon Kuskokwim Health Corporation, Bethel, AK, USA
| | - John Clark
- Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Ellen Hodges
- Research Department, Yukon Kuskokwim Health Corporation, Bethel, AK, USA
| | - Gretchen Day
- Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gregory Redding
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Mindaye ET, Tesfay GK, Erge MG. Pediatric bronchiectasis: An orphan disease ending in pneumonectomy: A case report. Int J Surg Case Rep 2020; 77:822-825. [PMID: 33395904 PMCID: PMC7724095 DOI: 10.1016/j.ijscr.2020.11.119] [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: 11/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
Pediatric bronchiectasis causes early decline in lung function. Treatment of paediatric bronchiectasis should be multidisciplinary. Surgical resection should be the last option to treat bronchiectasis in children. Neglected paediatric bronchiectasis is fatal.
Introduction Bronchiectasis is chronic infectious and inflammatory disease that results in irreversible thickening and dilatation of bronchi, and significant lung function decline in children. Prompt early diagnosis and multidisciplinary intervention is crucial to control recurrent exacerbation and preserve lung function. Presentation of case We present a case of pediatric bronchiectasis in a 10-year-old female who presented with a complaint of intermittent wet cough of 5 weeks’ duration associated with low grade intermittent fever, shortness of breath, easy fatigability and loss of appetite. Left pneumonectomy was done through left posterolateral thoracotomy and she was discharged home in good condition. Discussion Recurrent lower tract air way infections are the most common causes of pediatric bronchiectasis followed by primary immune deficiency, primary ciliary dyskinesia, foreign body aspiration and airway structural abnormalities. It is crucial to equip health care professionals with adequate knowledge about the disease as most pediatric patients may not have productive cough like adults leading to misdiagnosis or significant delay in diagnosis. High Resolution Computerized Tomography (HRCT) is the gold standard modality to diagnose and stratify severity of bronchiectasis. Conclusion Neglected pediatric bronchiectasis is associated with significant morbidity and mortality. So, it should be considered as differential diagnosis in children with recurrent respiratory symptoms as timely and prompt diagnosis is crucial for early intervention. Surgical resection is the last option of treatment for patients with bronchiectasis mainly reserved for those with recurrent infection despite adequate medical therapy.
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Affiliation(s)
- Esubalew Taddese Mindaye
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street 1271, Addis Ababa, Ethiopia.
| | - Goytom Knfe Tesfay
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Maru Gama Erge
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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Zeren M, Gurses HN, Denizoglu Kulli H, Ucgun H, Cakir E. Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity? Heart Lung 2020; 49:796-802. [PMID: 33010517 DOI: 10.1016/j.hrtlng.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests. METHODS Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO2 and dyspnea responses to tests were recorded. RESULTS Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties. CONCLUSIONS 30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.
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Affiliation(s)
- Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey.
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Chest Diseases, Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Abstract
RATIONALE Although bronchiectasis is conventionally considered a chronic pulmonary disease of adulthood, knowledge of pediatric bronchiectasis not related to cystic fibrosis started to emerge. Limited information in this field is available and the management is based on expert opinion. PATIENT CONCERNS An 8-year-old girl admitted for 7 days history of wet cough, purulent fetid sputum, shortness of breath and low-grade fever. The wet cough has presented for the past 4 years, during which she had frequent hospitalization for recurrent lower respiratory tract infections. DIAGNOSIS Chest high-resolution computerized tomography revealed diffuse bronchial dilations accompanied by inflammation in the bilateral lung fields. Microbiologic investigation for bronchoalveolar lavage fluid was positive for Pseudomonas aeruginosa. INTERVENTIONS With a working diagnosis of bronchiectasis with secondary pulmonary infection, sensitive cefoperazone-sulbactam was administrated for 14 days with gradual improvement of clinical symptoms. Bronchoscopy washing substantially soothed the symptoms, reducing the cough and sputum volumes. OUTCOMES The child was discharged after 14 days, and treated on long-term prophylactic antibiotic use (amoxicillin-clavulanic acid, 20 mg/kg/d, ≥ 4 weeks). LESSONS Although bronchiectasisis are condition in childhood, the diagnosis is suspected in children with persistent wet or productive cough, and should be confirmed by a chest high-resolution computerized tomography scan. Antibiotics and airway clearance techniques represent the milestones of bronchiectasis management although there are only a few guidelines in children.
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Affiliation(s)
- Ting Zhu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Angela Vinturache
- Department of Obstetrics and Gynecology, Queen Elizabeth II Hospital, Alberta, Canada
| | - Guodong Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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de la Rosa Carrillo D, Prados Sánchez C. Epidemiología y diversidad geográfica de las bronquiectasias. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Eralp EE, Gokdemir Y, Atag E, Ikizoglu NB, Ergenekon P, Yegit CY, Kut A, Ersu R, Karakoc F, Karadag B. Changing clinical characteristics of non-cystic fibrosis bronchiectasis in children. BMC Pulm Med 2020; 20:172. [PMID: 32546272 PMCID: PMC7298950 DOI: 10.1186/s12890-020-01214-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 06/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background The prevalence of non-cystic fibrosis (CF) bronchiectasis is increasing in both developed and developing countries in recent years. Although the main features remain similar, etiologies seem to change. Our aim was to evaluate the clinical and laboratory characteristics of our recent non-CF bronchiectasis patients and to compare these with our historical cohort in 2001. Methods One hundred four children with non-CF bronchiectasis followed between 2002 and 2019 were enrolled. Age of diagnosis, underlying etiology and microorganisms in sputum culture were recorded. Clinical outcomes were evaluated in terms of lung function tests and annual pulmonary exacerbation rates at presentation and within the last 12 months. Results Mean FEV1 and FVC %predicted at presentation improved compared to historical cohort (76.6 ± 17.1 vs. 63.3 ± 22.1 and 76.6 ± 15.1 vs. 67.3 ± 23.1, respectively; p < 0.001). There was a significant decrease in pulmonary exacerbation rate from 6.05 ± 2.88 at presentation to 3.23 ± 2.08 during follow-up (p < 0.0001). In 80.8% of patients, an underlying etiology was identified. There was an increase in primary ciliary dyskinesia (PCD) (32.7% vs. 6.3%; p = 0.001), decrease in idiopathic cases (19.2% vs. 37.8%; p = 0.03) with no change in postinfectious and immunodeficiencies as underlying etiology. Sputum cultures were positive in 77.9% of patients which was 46.9% in the historical cohort (p = 0.001). Conclusion Baseline pulmonary function tests were better and distribution of underlying etiology had changed with a remarkable increase in diagnosis of PCD in the recent cohort.
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Affiliation(s)
- Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nilay Bas Ikizoglu
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Arif Kut
- Division of Pediatric Pulmonology, Maltepe University, School of Medicine, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
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Kim S, Kim D, Bae WY, Jung JA. A Child who has Nasal Polyposis Combined with Bronchiectasis. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2020.00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Nasal polyps are inflammatory lesions of sinonasal tissue that are associated with chronic rhinosinusitis, allergic reaction, and other diseases. Although it is the most common cause of nasal polyps, chronic inflammation of the nasal cavity is not common in children. When nasal polyps are found in childhood, it is important to investigate the cause, such as immunodeficiency disease, cystic fibrosis, primary ciliary dyskinesia, and other syndromes such as Woakes’ syndrome. We report a child who presented with nasal polyps combined with bronchiectasis with a review of related literature.
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Dogru D, Polat SE, Tan Ç, Tezcan İ, Yalçın SS, Utine E, Oğuz B, Yaz İ, Emiralioğlu N, Hızal M, Yalçın E, Özçelik U, Çağdaş D, Kiper N. Impact of mannose-binding lectin 2 gene polymorphisms on disease severity in noncystic fibrosis bronchiectasis in children. Pediatr Pulmonol 2020; 55:1190-1198. [PMID: 32119194 DOI: 10.1002/ppul.24711] [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: 11/29/2019] [Accepted: 02/22/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mannose-binding lectin (MBL) is a complement protein involved in the innate immune system, and is associated with some chronic respiratory diseases including noncystic fibrosis (non-CF) bronchiectasis in adults. The aim of this study was to investigate the frequency of MBL2 gene polymorphisms in children with non-CF bronchiectasis, and the effect of MBL deficiency on disease severity. METHODS Fifty children with non-CF bronchiectasis (bronchiectasis group) and 50 healthy controls (control group) were included. The demographic findings, number of acute pulmonary exacerbations in the previous year, airway cultures, pulmonary function tests, and radiologic scores of the bronchiectasis group were recorded. DNA extraction was performed in both groups and MBL2 gene polymorphisms in codons 52, 54, 57 in exon 1 and H/L, Y/X in the promoter region were studied using real-time polymerase chain reaction. Haplotypes were made by genotypes, and MBL serum expression was classified according to the genotypes in the literature. RESULTS The bronchiectasis group consisted of 23 (46%) patients with primary ciliary dyskinesia, 5 (10%) with primary immunodeficiency diseases, and 22 (44%) with idiopathic bronchiectasis. There were no statistically significant differences between the bronchiectasis and control groups in terms of allele and genotype frequencies of polymorphisms in codons 52, 54, 57 in exon 1 and promoter H/L. However, the YX heterozygote genotype was more frequent in the control group (82%) compared with the bronchiectasis group (50%) (P = .002). The frequency of patients with intermediate serum MBL expression genotype was higher in the bronchiectasis group (20%) than in the control group (0%) (P = .001). In the bronchiectasis group, there were no significant differences in growth, annual pulmonary exacerbation rates in the last year, pulmonary function tests, radiologic scores, and microbiologic findings between low, intermediate, and high-expressing genotypes. CONCLUSIONS In children with non-CF bronchiectasis, MBL genotype was different from healthy controls. MBL deficiency associated only with MBL genotype was not related to disease severity in this group of patients.
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Affiliation(s)
- Deniz Dogru
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem E Polat
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Çağman Tan
- Department of Pediatrics, Division of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlhan Tezcan
- Department of Pediatrics, Division of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sıddıka S Yalçın
- Department of Pediatrics, Division of Social Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eda Utine
- Department of Pediatrics, Division of Pediatric Genetics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Oğuz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İsmail Yaz
- Department of Pediatrics, Division of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mina Hızal
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Uğur Özçelik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Çağdaş
- Department of Pediatrics, Division of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Goyal V, McPhail SM, Hurley F, Grimwood K, Marchant JM, Masters IB, Chang AB. Cost of hospitalization for bronchiectasis exacerbation in children. Respirology 2020; 25:1250-1256. [PMID: 32358912 DOI: 10.1111/resp.13828] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite paediatric bronchiectasis being recognized increasingly worldwide, prior reports of hospitalization costs for bronchiectasis in children are lacking. This study aimed to (i) identify health service costs of hospitalizations and (ii) factors associated with these costs in children admitted to an Australian paediatric hospital following an acute exacerbation of their bronchiectasis. METHODS Demographic and hospital resource use data were prospectively recorded for 100 hospitalizations in 80 children aged <18 years admitted consecutively to the QCH, Brisbane, Australia. Costs (2016 AUD) were obtained from the hospital's Finance Department. Linear regressions, with bootstrap resampling to quantify uncertainty, were used to estimate factors affecting cost of hospitalization. RESULTS The 100 hospitalizations (48 males) had a median (IQR) age of 6.04 (4.04-9.85) years. Their mean (SD) LOS was 12.30 (4.60) days. The mean (SD) direct health service cost was AUD 30 182 (13 998) per hospitalization. The greatest contributor to costs was health professional wages, accounting for 70% of the cost per episode. LOS, younger age at admission and number of bronchiectatic lobes affected were associated with higher costs, whilst HITH service was associated with lower cost. The cost to families on average was AUD 2669.50 (SD: 991.50) per hospitalization when accounting for lost wages and opportunity cost. CONCLUSION The per episode healthcare cost burden of hospitalizations for paediatric bronchiectasis exacerbations is substantial. Interventions that prevent hospitalized exacerbations and reduce severity of childhood bronchiectasis with even moderate effectiveness are likely to result in substantial hospital costs savings.
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Affiliation(s)
- Vikas Goyal
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Clinical Informatics, Metro South Health, Brisbane, QLD, Australia
| | - Frank Hurley
- Department of Finance, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, QLD, Australia.,Department of Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - I Brent Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,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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O'Rourke C, Schilling S, Martin R, Joyce P, Bernadette Chang A, Kapur N. Is out-patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment? Pediatr Pulmonol 2020; 55:994-999. [PMID: 32068973 DOI: 10.1002/ppul.24670] [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: 10/13/2019] [Accepted: 01/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Children with bronchiectasis have recurrent exacerbations and may require hospitalization. "Hospital in the home (HITH)" is used as an alternative to hospitalization for children with cystic fibrosis (CF) but to date, there is no published data on children without CF. We describe our experience of HITH (intravenous [IV] antibiotics and at least once-daily physiotherapy-treated airway clearance therapy) in a cohort of children with bronchiectasis, comparing outcomes between hospital and HITH-based pathways. METHODS Medical records were retrospectively reviewed in children with bronchiectasis who were hospitalized in our center from July 2016 to July 2018. We compared treatment duration, symptom resolution, adverse events, oral antibiotic prescription on discharge and "time-to-next hospitalization" between children managed with the two treatment pathways. RESULTS Exacerbations in 63 children (median age = 6 years [range: 1-17]; females = 33, indigenous = 8) with bronchiectasis treated with IV antibiotic therapy were analyzed (HITH n = 45, 71.5%). Duration of treatment and symptom resolution was similar between groups (hospital: median = 14 days [interquartile range {IQR}: 14-14] and 12/18 [66.6%], respectively vs HITH: 14 [14-15.5] and 31/45 [69%]; P = .53 and .85, respectively). There was no significant difference in adverse events (16.6% vs 9%), prescription of oral antibiotics on discharge (44% vs 24%), or "time-to-next hospitalization" (median 42 [IQR: 24-100] vs 67 [IQR: 32-95] weeks) between hospital and HITH groups, respectively. CONCLUSIONS In children with bronchiectasis treated for a severe exacerbation, receiving treatment in the home setting with HITH does not compromise short-term clinical outcomes compared to hospital only treatment. Prospective studies are required to provide more robust evidence in this under-researched area.
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Affiliation(s)
- Claudia O'Rourke
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia
| | - Sandra Schilling
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia
| | - Rebecca Martin
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia
| | - Patrick Joyce
- Department of Paediatric Medicine, School of Medicine, University of Queensland, Queensland, Australia
| | - Anne Bernadette Chang
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Paediatrics, Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nitin Kapur
- Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Queensland, Australia.,Department of Paediatric Medicine, School of Medicine, University of Queensland, Queensland, Australia.,Department of Paediatrics, Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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McCallum GB, Singleton RJ, Redding GJ, Grimwood K, Byrnes CA, Valery PC, Mobberley C, Oguoma VM, Eg KP, Morris PS, Chang AB. A decade on: Follow-up findings of indigenous children with bronchiectasis. Pediatr Pulmonol 2020; 55:975-985. [PMID: 32096916 DOI: 10.1002/ppul.24696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/08/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The sole prospective longitudinal study of children with either chronic suppurative lung disease (CSLD) or bronchiectasis published in the current era was limited to a single center. We sought to extend this study by evaluating the longer-term clinical and lung function outcomes and their associated risk factors in Indigenous children of adolescents from Australia, Alaska, and New Zealand who participated in our previous CSLD or bronchiectasis studies during 2004-2010. METHODS Between 2015 and 2018, we evaluated 131 out of 180 (72.8%) children of adolescents from the original studies at a single follow-up visit. We administered standardized questionnaires, reviewed medical records, undertook clinical examinations, performed spirometry, and scored available chest computed tomography scans. RESULTS Participants were seen at a mean age of 12.3 years (standard deviation: 2.6) and a median of 9.0 years (range: 5.0-13.0) after their original recruitment. With increasing age, rates of acute lower respiratory infections (ALRI) declined, while lung function was mostly within population norms (median forced expiry volume in one-second = 90% predicted, interquartile range [IQR]: 81-105; forced vital capacity [FVC] = 98% predicted, IQR: 85-114). However, 43 out of 111 (38.7%) reported chronic cough episodes. Their overall global rating judged by symptoms, including ALRI frequency, examination findings, and spirometry was well (20.3%), stable (43.9%), or improved (35.8%). Multivariable regression identified household tobacco exposure and age at first ALRI-episode as independent risk factors associated with lower FVC% predicted values. CONCLUSION Under our clinical care, the respiratory outcomes in late childhood or early adolescence are encouraging for these patient populations at high-risk of premature mortality. Prospective studies to further inform management throughout the life course into adulthood are now needed.
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Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rosalyn J Singleton
- Department Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska.,Arctic Investigators Program, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Anchorage, Alaska
| | - Gregory J Redding
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Keith Grimwood
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Infection and Immunology Division, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine A Byrnes
- The University of Auckland and Starship Children's Hospital, Auckland, New Zealand
| | - Patricia C Valery
- Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Charmaine Mobberley
- The University of Auckland and Starship Children's Hospital, Auckland, New Zealand
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kah Peng Eg
- Respiratory and Sleep Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Queensland, Australia
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48
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Chellew N, Chang AB, Grimwood K. Azithromycin Prescribing by Respiratory Pediatricians in Australia and New Zealand for Chronic Wet Cough: A Questionnaire-Based Survey. Front Pediatr 2020; 8:519. [PMID: 32984223 PMCID: PMC7492546 DOI: 10.3389/fped.2020.00519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022] Open
Abstract
Aims: To determine how respiratory pediatricians across Australia and New Zealand prescribe azithromycin for children with chronic wet cough, including recurrent protracted bacterial bronchitis, chronic suppurative lung disease (CSLD) and bronchiectasis. Methods: A prospective web-based questionnaire was emailed to members of the Pediatric Special Interest Group of the Thoracic Society of Australia and New Zealand (TSANZ) between April and May 2018. It comprised eight demographic and 15 clinically focused questions. Results: Of the 73 respiratory pediatricians listed across Australia and New Zealand, 29 (40%) responded and all prescribed azithromycin for chronic wet cough. Twelve (41%) indicated that they would consider prescribing a short-course (2-4 weeks) of azithromycin for children with a chronic wet cough. Although most respondents reported prescribing long-term (>4-weeks) azithromycin for either CSLD (n = 23, 79%) or bronchiectasis (n = 24, 83%), only nine (31%) respondents would commence treatment if in the previous 12-months these children experienced three non-hospitalized exacerbations and just 12 (41%) would do so if there had been two hospitalisations for severe exacerbations during the same period in accordance with the TSANZ national guidelines. A lower threshold for prescribing azithromycin was described for Indigenous children or if co-morbidities were present. None prescribed azithromycin for >24-months. Macrolide-resistance was reported in Streptococcus pneumoniae and Staphylococcus aureus. Conclusion: Although Australian and New Zealand respiratory pediatricians in this survey prescribed azithromycin for chronic wet cough most often in children with either CSLD or bronchiectasis, many did so outside the current national guidelines. Reasons for this need exploring.
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Affiliation(s)
- Naomi Chellew
- Department of Paediatrics, Gold Coast Health, Southport, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- Department of Paediatrics, Gold Coast Health, Southport, QLD, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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49
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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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50
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Cox NS, Wilson CJ, Bennett KA, Johnston K, Potter A, Chang AB, Lee AL. Health-related quality of life and psychological wellbeing are poor in children with bronchiectasis and their parents. ERJ Open Res 2019; 5:00063-2019. [PMID: 31528635 PMCID: PMC6734007 DOI: 10.1183/23120541.00063-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
Bronchiectasis is characterised by chronic wet cough, a cycle of inflammation, impaired mucociliary clearance, bacterial colonisation and infection [1]. People with bronchiectasis experience substantial disease burden, including recurrent hospitalisations and impaired quality of life (QoL) [2]. The prevalence and burden of bronchiectasis is increasingly appreciated worldwide [3]. Children with bronchiectasis in a stable state have poor HRQoL and their parents report higher levels of anxiety and depression. Parental perception of HRQoL is associated with poorer parental psychological wellbeing.http://bit.ly/2lcf3uB
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Affiliation(s)
- Narelle S Cox
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | | | | | - Kylie Johnston
- School of Health Sciences, University of SA, Adelaide, Australia
| | - Angela Potter
- Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Anne B Chang
- 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.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Annemarie L Lee
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia
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