Chronic Cough/Bronchiectasis – Pediatrics
From Guide to YKHC Medical Practices
Pathophysiology: Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of 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
- Environmental 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 contributing: attention to nutrition, detect complications, pollutants
- Systemic care: regular review, multi-disciplinary care, education, enhance self care and management
- Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year
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
- Lewis, T. et al. Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
- Healthy Homes Study
- YKHC Clinical Guideline for Bronchiectasis
