Chronic Wet Cough and Protracted Bacterial Bronchitis: update
Wet or productive cough is common in children with chronic cough. This update of the 2006 CHEST Cough Guidelines relating to chronic wet cough in children has resulted in new recommendations. The clinical diagnostic entity of PBB, not mentioned in the 2006 guidelines, is now recognized.
For children with chronic wet or productive cough unrelated to an underlying disease and without any specific cough, they recommend that children receive antibiotics therapy targeted to common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis). In general, a 2-week course is sufficient but up to 4 weeks may be required in a minority of children.
For children with chronic wet or productive cough unrelated to an underlying disease and without any specific cough pointers and whose cough resolves within 2 weeks of treatment with antibiotics targeted to local antibiotic sensitivities, the diagnosis of protracted bacterial bronchitis (PBB) should be made.
Investigations should be undertaken when cough pointers are present or when the wet cough does not resolve following the use of antibiotics. Flexible bronchoscopy with BAL and/or chest CT scans or assessment of immunity are the tests most commonly performed in this cases. Children with chronic wet cough that does not resolve after 4 weeks of appropriate oral antibiotics have an increased likelihood of CT scan-diagnosed bronchiectasis.
CHEST 2017; 151(4):884-890