Hermann Jan, Brückner Karen, Koerner-Rettberg Cordula, Dillenhöfer Stefanie, Brinkmann Folke, Maier Christoph, Heyer Christoph M, Schlegtendal Anne
Department of Paediatric Pneumology, University Children's Hospital, Ruhr-University, Bochum, Bochum, Germany.
Department of Anesthesiology and Intensive Care Medicine, St. Josef and St. Elisabeth-Hospital, Ruhr-University Bochum, Bochum, Germany.
Pediatr Pulmonol. 2025 May;60(5):e71111. doi: 10.1002/ppul.71111.
There is little information about long-term changes in pulmonary function tests (PFTs) many years after protracted bacterial bronchitis (PBB), the most common cause of chronic wet cough in early childhood.
Of 200 consecutively recruited children with a previously proven diagnosis of PBB 62 (12.2 years, female 48%) were interviewed after 7.7 (5.4-14.7) years about their previous and current symptoms and pulmonary function tests (PFTs: spirometry, body plethysmography, nitrogen multi-breath washout, exhaled nitric oxide and nasal nitric oxide) were performed. Children with persistent symptoms were offered lung imaging.
11 (17.7%) patients suffered from chronic or recurring wet cough years after their first PBB episode. 15 (24.19%) had at least one abnormal spirometry parameter. FEV1 was abnormal in eight of 62 (12.9%), LCI 2.5% in seven of 56 (12.5%), FVC in 12 of 62 (19.35%) and FEV1/FVC in five of 62 (8.06%) cases. PFT did not differ between children with and without wet cough. Lung MRI/CT demonstrate in four of nine cases abnormalities of the bronchial walls, including one with incipient bronchiectasis.
After PBB in early childhood, a significant proportion of children suffer from respiratory symptoms many years later, some have an objectively reduced lung function and structural changes of the bronchial wall despite adequate initial therapy. Wet cough alone seems not to be a sensitive clinical predictor. Due to the retrospective study design, we cannot proof any causal relationship. However, to detect late bronchopulmonary sequelae, continuous follow-up of these children should become mandatory.
迁延性细菌性支气管炎（PBB）是幼儿慢性湿性咳嗽最常见的病因，关于PBB多年后肺功能测试（PFTs）的长期变化的信息很少。
在连续招募的200例先前确诊为PBB的儿童中，7.7（5.4 - 14.7）年后对62例（12.2岁，女性占48%）进行了访谈，询问他们既往和当前的症状，并进行了肺功能测试（PFTs：肺活量测定、体容积描记法、多次呼吸氮洗脱、呼出一氧化氮和鼻一氧化氮）。对有持续症状的儿童进行了肺部成像检查。
11例（17.7%）患者在首次PBB发作多年后患有慢性或复发性湿性咳嗽。15例（24.19%）至少有一项肺活量测定参数异常。62例中有8例（12.9%）第一秒用力呼气容积（FEV1）异常，56例中有7例（12.5%）的肺清除指数（LCI）2.5%异常，62例中有12例（19.35%）用力肺活量（FVC）异常，62例中有5例（8.06%）FEV1/FVC异常。有湿性咳嗽和无湿性咳嗽的儿童之间的PFT没有差异。肺部磁共振成像/计算机断层扫描（MRI/CT）显示9例中有4例支气管壁异常，其中1例有早期支气管扩张。
幼儿期患PBB后，相当一部分儿童多年后仍有呼吸道症状，尽管初始治疗充分，但一些儿童的肺功能客观上有所下降，且支气管壁有结构改变。仅湿性咳嗽似乎不是一个敏感的临床预测指标。由于本研究为回顾性设计，我们无法证明任何因果关系。然而，为了检测晚期支气管肺后遗症，对这些儿童进行持续随访应成为强制性措施。
