Advertisement

Der Pneumologe

, Volume 16, Issue 1, pp 27–32 | Cite as

Chronischer Husten – eitrige Atemwegserkrankungen bei Kindern

  • J. RiedlerEmail author
Leitthema
  • 134 Downloads

Zusammenfassung

Ein chronisch feuchter Husten ist meist Ausdruck einer eitrigen Atemwegserkrankung. Dazu zählen die protrahierte bakterielle Bronchitis (PBB), die chronisch eitrige Atemwegs‑/Lungenkrankheit („chronic suppurative lung disease“, CSLD) und die Bronchiektasie. Verschiedene Endotypen dieser Krankheiten sind bekannt. Die PBB ist definiert als mehrwöchige bronchiale Infektion durch Bakterien, wodurch es zu täglichem feuchtem Husten über mindestens 4 Wochen kommt. Virale Infekte gehen häufig voraus und andere chronische eitrige Atemwegserkrankungen müssen ausgeschlossen werden. Die Diagnose wird primär klinisch gestellt („PBB klinisch“) und eine 2‑ bis 4‑wöchige orale Antibiotikagabe führt bei der Hälfte der Kinder zu einer deutlichen Besserung. Bei den restlichen Kindern soll eine genauere Abklärung mittels Thorax-Röntgenaufnahme, Lungenfunktionsmessung, flexibler Bronchoskopie und bronchoalveolärer Lavage und evtl. weiterer Untersuchungen erfolgen. Die häufigsten nachgewiesenen Bakterien sind Haemophilus influenzae, Moraxella catarrhalis und Streptococcus pneumoniae. Potenzielle weitere Therapieoptionen, die bisher noch nicht ausreichend in Studien für diese Indikation untersucht wurden, sind tägliche Inhalationen mit hyperosmolarer Lösung und verschiedene Formen thorakaler Physiotherapie.

Schlüsselwörter

Lungenerkrankung Chronische Bronchitis Bakterieller Infektion Haemophilus influenzae Antibiotika 

Chronic cough—suppurative airway diseases in children

Abstract

Chronic wet cough is in most cases an expression of chronic suppurative airway diseases, such as protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. The PBB is defined as a chronic (several weeks) bronchial infection and inflammation caused by bacteria, the presence of isolated chronic wet cough and the absence of indicators suggestive of other specific chronic airway diseases. Primarily, it is diagnosed clinically (PBB clinical) and the cough resolves only after a prolonged course of appropriate antibiotics. Almost half of the affected children need several courses of antibiotics and many suffer a relapse. In these children, further investigations such as imaging, lung function testing, bronchoscopy, bronchoalveolar lavage and exclusion of alternative conditions are warranted. The most common pathogens found in bronchial secretions of children with PBB are Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumonia. Additional treatment options, which have not yet been sufficiently investigated for these indications are daily inhalation of hyperosmolar solutions and various forms of chest physiotherapy.

Keywords

Pulmonary disease Chronic Bronchitis  Bacterial infection Haemophilus influenzae Antibiotics 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Riedler gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Baines KJ, Upham JW, Yerkovich ST, Chang AB, Marchant JM, Carroll M, Simpson JL, Gibson PG (2014) Mediators of neutrophil function in children with protracted bacterial bronchitis. Chest 146(4):1013–1020PubMedGoogle Scholar
  2. 2.
    Bush A (2017) Persistent bacterial bronchitis: time to venture beyond the umbrella. Front Pediatr.  https://doi.org/10.3389/fped.2017.00264 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Chang AB, Brown N, Toombs M, Marsh RL, Redding GJ (2014) Lung disease in indigenous children. Paediatr Respir Rev 15(4):325–332PubMedGoogle Scholar
  4. 4.
    Chang AB, Redding GJ, Everard ML (2008) Chronic wet cough: protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 43:519–531PubMedGoogle Scholar
  5. 5.
    Chang A, Oppenheimer J, Weinberger M (2017) Use of management pathways or algorithms in children with chronic cough. Chest 151(4):875–883PubMedGoogle Scholar
  6. 6.
    Chang A, Oppenheimer J, Weinberger M (2017) Management of children with chronic wet cough and protracted bacterial bronchitis. Chest 151(4):884–890PubMedGoogle Scholar
  7. 7.
    Chang AB, Upham JW, Masters IB (2016) Protracted bacterial bronchitis: the last decade and the road ahead. Pediatr Pulmonol 51(3):225–242PubMedGoogle Scholar
  8. 8.
    Chang AB, Oppenheimer JJ, Weinberger M et al (2016) Children with chronic wet or productive cough-treatment and investigations: a systematic review. Chest 149(1):120–142PubMedGoogle Scholar
  9. 9.
    Chang AB, Oppenheimer JJ, Weinberger M et al (2017) Management of children with chronic wet cough and protracted bacterial bronchitis:chest guideline and expert panel report. Chest 151(4):884–890PubMedGoogle Scholar
  10. 10.
    Craven V, Everard ML (2012) Protracted bacterial bronchitis: reinventing an old disease. Review 98:72–76Google Scholar
  11. 11.
    Donnelly DE, Critchlow A, Everard ML (2007) Outcomes in children treated for persistent bacterial bronchitis. Thorax 62:80–84PubMedGoogle Scholar
  12. 12.
    Eg KP, Mirra V, Chang AB, Santamaria F (2017) Editorial: chronic suppurative lung disease and bronchiectasis in children and adolescents. Front Pediatr.  https://doi.org/10.3389/fped.2017.00196 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Goyal V, Grimwood K, Marchant JM et al (2016) Paediatric chronic suppurative lung disease:clinical characteristics and outcomes. Eur Respir J 175(8):1077–1084Google Scholar
  14. 14.
    Goyal V, Grimwood K, Marchant JM et al (2014) Does failed chronic wet cough response to antibiotics predict bronchiectasies? Arch Dis Child 99:522–525PubMedGoogle Scholar
  15. 15.
    Grissell T, Chang AB, Gibson PG (2007) Impaired toll-like receptor 4 and substance P gene expression is linked to airway bacterial colonisation in children. Pediatr Pulmonol 42:380–385PubMedGoogle Scholar
  16. 16.
    Hare KM, Smith-Vaughan HC, Leach AJ et al (2018) Reduced nontypeable Haemophilus influenzae lower airway infection in children with chronic endobronchial suppuration vaccinated with the 10-valent pneumococcal H.influenzae protein D conjugate vaccine. Vaccine 36(13):1736–1742PubMedGoogle Scholar
  17. 17.
    Kantar A, Chang AB, Shields M et al (2017) ERS statement on protracted bacterial bronchitis in children. Eur Respir J.  https://doi.org/10.1183/13993003.02139-2016 CrossRefPubMedGoogle Scholar
  18. 18.
    Kelly C, Chalmers JD, Crossingham I et al (2018) Makrolide antibiotics for bronchiectasis. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD012406.pub2 CrossRefPubMedGoogle Scholar
  19. 19.
    Kompare M, Weinberger M (2012) Protracted bacterial bronchitis in young children: association with airway malacia. J Pediatr 160(1):88–92PubMedGoogle Scholar
  20. 20.
    Luyt DK, Burton PR, Simpson H (1993) Epidemiological study of wheeze, doctor diagnosed asthma, and cough in preschool children in Leicestershire. Br Med J 306:1386–1390Google Scholar
  21. 21.
    Marchant J, Masters IB, Champion A, Petsky H, Petsky H, Chang AB (2012) Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax 67(8):689–693PubMedGoogle Scholar
  22. 22.
    Marchant J, Morris PS, Gaffney J, Chang AB (2011) Antibiotics for prolonged moist cough in children. Cochrane Database Syst Rev 2:CD4822Google Scholar
  23. 23.
    Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB (2006) Evaluation and outcome of young children with chronic cough. Chest 129:1132–1141PubMedGoogle Scholar
  24. 24.
    Narang R, Bakewell K, Peach J, Clayton S, Samuels M, Alexander J, Lenney W, Gilchrist FJ (2014) Bacterial distribution in the lungs of children with protracted bacterial bronchitis. PLoS ONE 9(9):e108523PubMedPubMedCentralGoogle Scholar
  25. 25.
    Parnham MJ, Erakovic HV, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R (2014) Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther 143(2):225–245PubMedGoogle Scholar
  26. 26.
    Priftis KN, Litt D, Manglani S, Anthracopoulos MB, Thickett K, Tzanakaki G, Fenton P, Syrogiannopoulos GA, Vogiatzi A, Douros K, Slack M, Everard ML (2013) Bacterial bronchitis caused by Streptococcus pneumoniae and nontypable Haemophilus influenzae in children: the impact of vaccination. Chest 154(1):152–157Google Scholar
  27. 27.
    Pritchard MG, Lenney W, Gilchrist FJ (2015) Outcomes in children with protracted bacterial bronchitis confirmed by bronchoscopy. Arch Dis Child 100:112PubMedGoogle Scholar
  28. 28.
    Riedler J (2015) Protrahiert-bakterielle Bronchitis. Monatsschr Kinderheilkd 163:1241–1245Google Scholar
  29. 29.
    Shields MD, Doherty GM (2013) Chronic cough in children. Paediatr Respir Rev 14(2):100–105PubMedGoogle Scholar
  30. 30.
    Strálin K, Korsgaard J, Olicén P (2006) Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage. Respir J 28(3):568–575Google Scholar
  31. 31.
    Taussig LM, Smith SM, Blumenfeld R (1981) Chronic bronchitis in childhood: what is it? Pediatr Electron Pages 67:1–5Google Scholar
  32. 32.
    Wurzel DF, Mackay IM, Marchant JM, Wang CY, Yerkovich ST, Upham JW, Smith-Vaughan HC, Petsky HL, Chang AB (2014) Adenovirus species C is associated with chronic suppurative lung diseases in children. Clin Infect Dis 59(1):34–40PubMedPubMedCentralGoogle Scholar
  33. 33.
    Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Mackay IM, Masters IB, Chang AB (2014) Prospective characterization of protracted bacterial bronchitis in children. Chest 145(6):1271–1278PubMedGoogle Scholar
  34. 34.
    Zacharasiewicz A, Eber E, Riedler J, Frischer T (2015) Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 163:248–256Google Scholar
  35. 35.
    Zgherea D, Pagala S, Mendiratta M, Marcus MG, Shelov SP, Kazachkov M (2012) Bronchoscopic Findings in children with chronic wet cough. Pediatr Electron Pages 129:e364–e369Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Abteilung für Kinder- und JugendmedizinKardinal Schwarzenberg KlinikumSchwarzach/PongauÖsterreich

Personalised recommendations