Protracted Bacterial Bronchitis (PBB)

Pt < 6 y/o with h/o asthma presents with cough x 4 weeks. Parents describe wet/moist, productive nighttime cough that interferes with sleep, SOB, intermittent wheezing. Asthma symptoms well controlled before 4 weeks ago and parents deny exposure to any asthma triggers. Afebrile and well appearing with rattling lung sounds on exam.

• CXR shows bilateral peribronchial accentuation with focal consolidated infiltrates; negative for foreign body aspiration

• Start amoxicillin/clavulanate (Augmentin) x 2 weeks

• Parents advised to schedule appointment if symptoms do not resolve s/p antibiotic course

Notes

• Chronic cough in children defined as >4 weeks

• PBB is estimated to be the 2nd most common cause of cough in children < 6 y/o (asthma = 36%, PBB = 12%, upper airway cough syndrome = 9%)

• CXR showing bilateral peribronchial accentuation with focal infiltrates may indicate PBB or asthma

• If untreated, PBB can result in bronchiectasis

• See Chest 2017; 151:884 and Ann Thorac Med. 2018 Jan-Mar; 13(1): 7–13 for further information