https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29719 4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1ß signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.]]> Wed 23 Feb 2022 16:05:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55045 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. Changes in management as a result of this statement: ; Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. ; High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. ; Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. ; Early and effective treatment of chronic wet/productive cough in children is critical. ; Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. ; If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.]]> Thu 04 Apr 2024 13:51:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20295 Sat 24 Mar 2018 07:55:14 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4817 Sat 24 Mar 2018 07:18:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23311 Sat 24 Mar 2018 07:13:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46104 adj = 9.6, 95% CI: 1.8–50.1) and the presence of Haemophilus influenzae in the BAL (OR_adj = 5.1, 95% CI: 1.4–19.1). Clinician-diagnosed asthma at final follow-up was present in 27.1% of children with PBB. A significant BDR (FEV₁ improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen-specific IgE (OR_adj = 14.8, 95% CI: 2.2–100.8) at baseline and bronchomalacia (OR_adj = 5.9, 95% CI: 1.2–29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. Conclusion: As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required.]]> Mon 21 Nov 2022 09:17:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35554 Prevotella species. Alpha diversity was unrelated to bacterial biomass, culture of recognized respiratory pathogens, or inflammatory markers. Conclusions: Neutrophilic inflammation in children with PBB was associated with multiple BAL microbiota profiles. Significant associations between inflammatory markers and bacterial biomass, but not alpha diversity, suggest that inflammation in children with PBB is not driven by single pathogenic species. Understanding the role of the entire respiratory microbiota in PBB pathogenesis may be important to determining whether bacteria other than the recognized pathogens contribute to disease recurrence and progression to bronchiectasis.]]> Fri 31 Jan 2020 16:15:09 AEDT ]]>