An underestimated cause of chronic cough: The protracted bacterial bronchitis

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From: Annals of Thoracic Medicine(Vol. 13, Issue 1)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 4,590 words
Lexile Measure: 2030L

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Byline: Paola. Di Filippo, Alessandra. Scaparrotta, Marianna. Petrosino, Marina. Attanasi, Sabrina. Di Pillo, Francesco. Chiarelli, Angelika. Mohn

Chronic cough in childhood is associated with a high morbidity and decreased quality of life. Protracted bacterial bronchitis (PBB) seems to be the second most common cause of chronic cough in children under 6 years of age. Its main clinical feature is represented by wet cough that worsens when changing posture and improves after the introduction of antibiotics. Currently, the mainstay of PBB treatment is a 2-week therapy with a high dose of antibiotics, such as co-amoxiclav, to eradicate the infection and restore epithelial integrity. It is very important to contemplate this disease in a child with chronic cough since the misdiagnosis of PBB could lead to complications such as bronchiectasis. Clinicians, however, often do not consider this disease in the differential diagnosis and, consequently, they are inclined to change the antibiotic therapy rather than to extend it or to add steroids. Data sources of this review include PubMed up to December 2016, using the search terms 'child,' 'chronic cough,' and 'protracted bacterial bronchitis.'

Cough is the most common reason why a patient asks a doctor for a consultation.[1]

Pediatric chronic cough in children younger than 15 years of age is defined as a daily cough that persists longer than 4 weeks.[2]

Chronic cough in childhood is associated with a high morbidity and decreased quality of life scores,[3] impacting sleep and school attendance.[4]

In a recent study including 563 children with chronic cough, the most common final diagnoses were asthma (24.9%), asthma-like symptoms (19%), protracted bacterial bronchitis (PBB) (11.9%), and upper airway cough syndrome (9.1%). The frequency of causes changes according to age groups: PBB was the second most common cause in children under 6 years of age, whereas the psychogenic cough was the second common cause of cough in children over 6 years of age.[5]

PBB is frequently missed, misdiagnosed (e.g., as asthma), or inadequately treated,[6] resulting in a persistence of symptoms and potential structural damage of the respiratory system (bronchiectasis).[7]

Despite the increased clinical recognition, the underlying mechanisms of PBB remain to be clarified.


Lower respiratory tract bacterial infections may manifest as the classic bacterial pneumonia or as PBB. This syndrome is a relatively new clinical entity, first described in a study conducted in Australia in 2006.[8]

PBB is a protracted or persistent infection of conducting airways and it is clinically defined as the presence of chronic wet/moist cough for more than 4 weeks.[9] It is a common cause of chronic wet cough in children, and it was only recently described in pediatric or even respiratory pediatric textbooks and incorporated in national and international cough guidelines.[10]


The prevalence of chronic cough was estimated to be 8% in a study of 1165 Australian children and 566 Nigerian children,[11] although some studies reported higher percentages, up to 10% in both adults and children.[4]

Chronic cough represents a source of great frustration for parents and doctors. It has consequences on the child's...

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Gale Document Number: GALE|A522186101