Bronchoscopic and High-Resolution CT Scan Findings in Children With Chronic Wet Cough

3rd Department of Paediatrics, Attikon Hospital, Greece.
Chest (Impact Factor: 7.48). 03/2011; 140(2):317-23. DOI: 10.1378/chest.10-3050
Source: PubMed


Chronic wet cough strongly suggests endobronchial infection, which, if left untreated, may progress to established bronchiectasis. Our aim was to compare the effectiveness of chest high-resolution CT (HRCT) scanning and flexible bronchoscopy (FB) in detecting airway abnormalities in children with chronic wet cough and to explore the association between radiologic and bronchoscopic/BAL findings.
We retrospectively evaluated a selected population of 93 children (0.6-16.4 years) with wet cough for > 6 weeks who were referred to a specialized center and deemed unlikely to have asthma. All patients were submitted to hematologic investigations, chest radiographs (CXRs), HRCT scanning, and FB/BAL. HRCT scans were scored with the Bhalla method, and bronchoscopic findings of bronchitis were grouped into five grades of severity.
Positive HRCT scan findings were present in 70 (75.2%) patients (P = .76). A positive correlation was found between Bhalla score and duration of cough (ρ = 0.23, P = .028). FB/BAL was superior to HRCT scan in detecting abnormalities (P < .001). The Bhalla score correlated positively with type III (OR, 5.44; 95% CI, 1.92-15.40; P = .001) and type IV (OR, 8.91; 95% CI, 2.53-15.42; P = .001) bronchoscopic lesions; it also correlated positively with the percentage of neutrophils in the BAL (ρ = 0.23, P = .036).
HRCT scanning detected airway wall thickening and bronchiectasis, and the severity of the findings correlated positively with the length of clinical symptoms and the intensity of neutrophilic inflammation in the airways. However, HRCT scanning was less sensitive than FB/BAL in detecting airway abnormalities. The two modalities should be considered complementary in the evaluation of prolonged wet cough.

Download full-text


Available from: Kostas N Priftis
  • Source

    Full-text · Article · Aug 2011 · Chest
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 5-year-old boy who, 1 year prior to admission, had suffered adenovirus-induced pneumonia (Fig. 2.1). Since then, he has experienced frequent episodes of cough. Physical examination on admission revealed decreased breath sounds and some crackles in the left hemithorax. Inspiratory and expiratory AP chest X-rays and lung CT were obtained.
    No preview · Chapter · Jan 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract BACKGROUND:While the burden of chronic cough in children has been documented, etiological factors across multiple settings and age have not been described. In children with chronic cough, we aimed to: (1) evaluate the burden and etiologies using a standard management pathway in various settings, and determine the influence of; (2a) age and setting on disease burden and etiologies and; (2b) etiology on disease burden. We hypothesized that the etiology, but not the burden, of chronic cough in children is dependent on the clinical setting and age. METHODS:From 5 major hospitals and 3 rural-remote clinics, 346 children (mean age 4.5-yrs) newly referred with chronic cough (>4-weeks) were prospectively managed in accordance with an evidence-based cough algorithm. We used a-priori definitions, time-frames and validated outcome measures (cough-specific quality of life (PC-QOL), a generic QOL (PedsQL) and cough diary). RESULTS:The burden of chronic cough (PC-QOL, cough duration) significantly differed between settings (p=0.014, 0.021 respectively), but was not influenced by age or etiology. PC-QOL and PedsQL did not correlate with age. The frequency of etiologies was significantly different in dissimilar settings (p=0.0001); 17.6% of children had a serious underlying diagnosis (bronchiectasis, aspiration, cystic fibrosis). Except for protracted bacterial bronchitis, the frequency of other common diagnoses (asthma, bronchiectasis, resolved without specific-diagnosis) was similar across age categories. CONCLUSION:The high burden of cough is independent of children's age and etiology but dependent on clinical setting. Irrespective of setting and age, children with chronic cough should be carefully evaluated and child-specific evidence-based algorithms used.
    No preview · Article · Mar 2012 · Chest
Show more