Chronic wet cough associated with bronchitis in children

Zgherea D. Pediatrics. 2012;129:e364-e369.

Children who exhibited chronic wet cough were often found to have evidence of purulent bronchitis, indicative of a bacterial lower airway infection, according to a recent retrospective review published online.

To determine the frequency of bacterial bronchitis in children with chronic wet cough, researchers performed a review of charts and bronchoscopy reports of 260 children complaining of chronic wet cough who were referred by their primary care pediatricians to a pediatric pulmonary clinic at Maimonides Infants and Children’s Hospital in Brooklyn, N.Y., from 2004 to 2008. Exclusion criteria for this review consist of underlying diagnoses of aspiration, asthma, cystic fibrosis, immunodeficiency syndromes, genetic syndromes, muscle weakness, neurologic disorders, primary ciliary dyskinesia and significant airway abnormalities.

One hundred ninety-seven patients were included in the review, of whom 126 were boys, 108 were aged 0 to 3 years, 71 were aged 3 to 7 years and 18 were aged older than 7 years.

According to the review, 30.3% of the children aged 0 to 3 years had laryngomalacia, tracheomalacia or both. Laryngomalacia was seen in 20.3% of children with purulent bronchitis, and in 11.1% of children with nonpurulent bronchitis, whereas tracheomalacia was seen in 14.1% of children with purulent bronchitis and in 13.3% of children with nonpurulent bronchitis. Researchers observed no significant difference in the prevalence of laryngomalacia (P=.329) and tracheomalacia (P=.862) between the purulent and nonpurulent groups.

In addition, analysis of bronchoscopic findings demonstrated purulent bronchitis in 110 patients and nonpurulent bronchitis in 87 patients. Bronchoalveolar lavage bacterial cultures were positive in 91 patients and showed nontypable Haemophilus influenzae (49%), Moraxella catarrhalis (17%), Staphylococcus aureus (12%), Streptococcus pneumoniae (20%) and Klebsiella pneumoniae in a single patient. Further analysis showed that positive bacterial cultures occurred more frequently in children with purulent bronchitis (69.8%) than in children with nonpurulent bronchitis (19.8%; P<.001).

“A substantial number of children with chronic wet cough can be found to have a bacterial infection of the lower airway,” according to the researchers. “Presence of purulent bronchitis during bronchoscopy is strongly associated with bacterial lower airway infection in this population of patients. Laryngomalacia and tracheomalacia are frequently detected in children with chronic wet cough. Further prospective studies will be required to better define the relationships among chronic wet cough, bacterial bronchitis and asthma.”

Disclosure: The researchers report no relevant financial disclosures.

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