RT Journal Article
SR Electronic
T1 Protracted bacterial bronchitis and malacias: Which came first , the chicken or the egg?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4654
VO 44
IS Suppl 58
A1 Marcela Moreno
A1 Silvia Castillo
A1 Carolina Castaño
A1 Marta Trujillo
A1 Nora Sivó
A1 Amparo Escribano
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/4654.abstract
AB Aims: to determine the prevalence of airway malacias in children diagnosed with persistent bacterial bronchitis (PBB) and evaluate the influence of malacias on the development of PBB.Methods: review of all children diagnosed with PBB in the last 8 years [wet chronic cough, atelectasis, noisy breathing, >104 colony forming units per millilitre of bacteria in bronchoalveolar lavage (BAL)], and all children diagnosed with tracheo or/and bronchomalacia. We investigated, in the PBB group, the association with malacias and in the malacia group, those with PBB. Major diagnostic (cystic fibrosis, primary ciliary, dyskinesia and immunodeficiency) were excluded.Results: 142 children with malacias, 121/142 tracheomalacias (56 moderate, 20 severe), 57/142 bronchomalacias and 36/142 tracheobronchomalacias. 53 children with PBB of which 40 had malacias (mainly moderate tracheomalacia) and only 10/53 BBP, have not malacias. 71% patients with malacias no had PBB at the moment of BAL. Average age of diagnosis of PBB was 3 years. The main indication for bronchoscopy was persistent cough. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the most prevalent microorganisms. 24/53 PBB had neutrophilia in BAL. Most PBB were treated with amoxicillin clavulanate during 15-21 days, 72% responded favorably. 80% of those with unfavorable evolution had moderate to severe tracheomalacia.Conclusion: Patients PBB had high association with malacias, mainly moderate traqueomalacias, placing these functional abnormalities as a risk factor for persistent bronchial infection. This justify the empirical use of prolonged antibiotic treatment in patients with malacia and persistent bronchial symptoms.