Chronic Cough/Bronchiectasis – Pediatrics

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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:

  • Prematurity
  • Immunocompromise
  • Early recurrent respiratory infections
  • Previous injury
  • Environmental effects (lack of piped water, household crowding, woodstove use)

Demographics: Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000.
Signs/Symptoms: Chronic wet cough, respiratory exacerbations with fever, crackles, wheezing
Diagnosis: Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) to 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
  • Special attention in adolescents to transferring to adult care.

Critical Times for Affected Patients: exacerbations – antibiotic treatment important, prophylaxis if frequent exacerbations, transition to adulthood critical – poorly managed bronchiectasis can lead to early COPD and death

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses