Chronic Cough/Bronchiectasis – Pediatrics

Pathophysiology: Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and lossof elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions.
Risk Factors:

• low birth weight
• Prematurity
• Early recurrent respiratory infections
• Previous injury
• Enironmental effects (lack of piped water, household crowding, woodstove in the house)

Demographics: Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000. low income.
Signs/Symptoms: Chronic wet cough
Diagnosis: Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) and CT scan confirmed Bronchiectasis
Management:

• Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations
• Improve other factors contibuting: attention to nutrition, detect complications, pllutants
• Systemic care: regular review, multi-discplinary care, education, enhance self care and management

Critical Times for Affected Patients: during exacerbations, if untreated can lead to early COPD and death

Resources/References

• Bronchiectasis: Prevention and Management 2016 (Powerpoint Presentation by Rosalyn Singleton, MD)
• Singleton RJ et al. Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol 2014.
• Redding et al. Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis. CHEST 2014:146;762-4
• Healthy Homes Study
• YKHC Clinical Guideline for Bronchiectasis

category:YKHC Guidelines
Common/Unique Medical Diagnoses