Causal Analysis And Quality Of Life Assessment Of Children With Protracted Bacterial Bronchitis

BackgroundProtracted bacterial bronchitis(PBB)is a common cause of chronic cough in childhood.The incidence of PBB has increased in recent years and there is a tendency of prolonged course.The early stage of PBB is often misdiagnosed and mismanaged by pediatric physicians because of insufficient awareness,which will lead to irreversible damage to the bronchial lining and progress to bronchiectasis.PBB has varying degrees of impact on the lives of children and caregivers.This disease has been more frequently reported and studied by foreign scholars.Under the new situation of domestic three-year epidemic control and medical reform and strict control of antibacterial drugs,it is necessary to summarize and analyze the current clinical characteristics of PBB in children in China,its impact on the quality of life of children,and the causes of the prolonged course.So as to provide a real-time basis for clinicians to diagnose and treatment with PBB.Part 1 Clinical characteristics and pathogenetic analysis of PBB in children ObjectiveThis part summarized the clinical characteristics and common pathogens of PBB by analyzing the clinical data,which will provide a basis for early and accurate diagnosis and experiential treatment of PBB.MethodsChildren who were hospitalized at Qilu Hospital of Shandong University from April 2020 to November 2022 for a definite cause of prolonged cough and finally diagnosed with PBB were selected.Clinical data including:basic demographic information,clinical symptom characteristics,lung CT images and bronchoscopic features,pathogens and so on.SPSS 26.0 software were used to analyze the clinical characteristics and pathogenetic analysis of children with PBB.Results1.In this part of research,63 patients’ information was collected.Involving 41 males(65.1%)and 22 females(34.9%),with a 1.86:1 ratio of male to female.The median age of onset was 71(59,118)months,with a predominant age of 3-6 years old.The morbidity was essentially the same in all four seasons.Wet cough was the main symptom of PBB.The median cough duration of onset was 8(4,16)weeks.37 cases(58.7%)manifested aggravated cough symptoms after activity,after exposure to cold air,early morning,wee hours,and at night(one or more),and 33.3%(21/63)of children appeared wheezing.2.Among 63 hospitalized children,39 cases were detected bacteria positive.The bacterial culture positive rate was 3.2%(2/62),the nucleic acid PCR test positive rate was 16.7%(3/18),and the macrogenomics next generation sequencing(mNGS)positive rate was 100%(35/35).The top three bacterium detected were Streptococcus pneumoniae(17 cases,17/39),Haemophilus influenzae(7 cases,7/39),and Staphylococcus aureus(6 cases,6/39).Among them,18 cases(18/39)co-infected with viruses and 2 cases(2/39)co-infected with fungi.Resistance genes of Streptococcus pneumoniae were detected in 7 of 17 cases of Streptococcus pneumoniae infection,all suggesting resistance to macrolide antibiotics.3.Bronchoscopy in children with PBB manifestated inflammation.The bronchial mucosa appeared congestion.Secretions can be seen in the bronchial wall,partly accompanied by the formation of mucus plug deposits.The percentage of neutrophils in brochoalveolar lavage fluid(BALF)ranged from 0-95%,50%(20/40)cases exceeded 3.5%.4.Imaging manifestations:High-resolution CT examination of the lungs was performed after admission in 59 of 63 children,which showed mainly bronchitis with increased and vague lung texture.6 cases showed dotted lamellar density shadow,9 cases showed bronchial wall thickening signs,and 7 cases had non-uniform translucency.Conclusions1.PBB is most often occurred in male preschoolers aged 3-6 years.PBB has no obvious seasonal characteristics.In addition to chronic wet cough,some children have a cough with charateristics of cough variant asthma and may exhibit wheezing.2.The pathogens in children with PBB are still common bacterium such as Streptococcus pneumoniae,Haemophilus influenzae and Staphylococcus aureus,with a small number of combined viral and fungal infections.mNGS test has a high positive rate.3.In children with PBB,high-resolution CT of the lungs,bronchoscopy,and BALF pathogen testing can help clarify the diagnosis.Part 2 Factors influencing the duration of cough and quality of life assessment in children with PBBObjectiveBased on the first part of the study,this part further collect the humanistic information and clinical data of children with PBB in order to explore the appropriate course of treatment of infections,analyze the reasons for the prolonged cough course,and clarify the impact of PBB on children’ life quality.Raise awareness of PPB among parents and clinicians to reduce the occurrence and progression of PBB.This will increase parents and clinicians’ awareness of PPB and reduce the occurrence and progression of PBB.MethodsChildren who were hospitalized at Qilu Hospital of Shandong University from November 2021 to November 2022 and finally diagnosed with PBB were selected.At the first visit,humanistic information and clinical data were collected,including name,age,sex,residence,presence of siblings,average age of parents,education level of parents,identity of primary caregiver,underlying medical conditions,exposure to smoky environment,characteristics of the child’s cough,in-hospital and out-of-hospital treatments and so on.This information was used to explore the appropriate course of treatment of infections and the factors influencing the duration of cough.The Parent-Proxy cough-specific quality of life scale(PC-QOL)was completed by parents at the first visit and after treatment,and the Verbal category descriptive score(VCD)was completed by parents at the first visit,2 weeks of treatment,and 4 weeks of treatment,respectively.Children aged 6 years and above completed the Leicester cough questionnaire(LCQ).The cough symptom score was used to assess the severity of cough symptoms and treatment response,and the PC-QOL scale and LCQ scale were used to assess children’life quality.SPSS 26.0 software was used to complete statistical analysis.Results1.In this part of research,88 patients’ information was collected.The median duration of cough before attending our hospital was 8(4.5,16)weeks.The median duration of treatment of infections after attending our hospital was 3(2,4)weeks.30.7%(27/88)of the children had a 2-week course of antibiotics.33%(29/88)of the children had a 3-week course of antibiotics.27.3%(24/88)of the children had a 4-week course of antibiotics.There are 8 children(9%)with anti-infection course exceeding 4 weeks.The spearman correlation analysis showed that the course of treatment of infections correlated with the duration of cough(r=0.530,P<0.001),and the longer the duration of cough,the longer the course of treatment of infections.2.Analysis of variance and correlation revealed that the residence,parental literacy,correctness of caregiver’s judgment of cough nature,and whether to rest at home during coughing were factors influencing the cough duration(P<0.05);Gender,whether or not the only child,primary caregiver identity,presence of environmental exposure to smoking,out-of-hospital diagnosis of asthma or CVA and out-of-hospital treatment of infections were not factors affecting the cough duration(P>0.05).Multi-factor linear regression analysis revealed that the residence and whether to rest at home during coughing were independent influences on the cough duration(B=9.354,7.870;P<0.05).3.There was no statistically significant difference between daytime and nighttime cough symptom scores before treatment(P>0.05).The mean scores on the physical,psychological,and social domains of the LCQ scale of PBB children were 4.900±0.892,4.992±1.284,4.850±1.374,respectively,with a total score of 14.742±3.108.There was no statistically significant difference between the scores of different domains(P>0.05).The Cranbach’s a and KMO of the PC-QOL for every domain and overall were>0.8,which revealed that this scale had a good reliability and a structural validity.The mean scores on the physical,psychological,and social domains of the PC-QOL were 3.104±1.364,3.317±1.573,and 3.668±1.534,respectively,with a total score of 10.090±4.208.There was a statistically significant difference between the scores of different domains(P<0.05).There was no significant difference between the scores of psychological domain and physical domain and social domain(P>0.05),.There was a statistically significant difference between the scores of physical domain and social domain(P<0.05),and the scores of physical domain were significantly lower than the scores of social domain.There were statistically significant differences in the scores of the physical,psychological and social domains and total scores of the PC-QOL scale in children with PBB after treatment compared with those before treatment(P<0.001).All domain scores and total scores after treatment were significantly higher than before treatment.Correlation analysis revealed a positive correlation between the physical,psychological,social and total scores of the PC-QOL and the corresponding physical,psychological,social and total scores of the LCQ(r=0.571,P<0.001;r=0.479,P=0.004;r=0.584,P<0.001;r=0.655,P<0.001).Analysis of variance revealed statistically significant differences(P<0.05)between the scores of each domain and total scores of the PC-QOL compared with the corresponding scores of each domain and total scores of the LCQ,and the scores of each domain and total scores of the PC-QOL were significantly lower than those of the LCQ.Conclusions1.Children with PBB generally need an approximately 3-weeks course of antibiotics,the longer the duration of cough,the longer the course of treatment of infections.2.The residence,parental literacy,correctness of caregiver’s judgment of cough nature,and home rest situation during coughing were factors influencing the cough duration.The residence and home rest situation during coughing were independent influences on the cough duration.3.Experiential treatment with conventional antibiotics does not shorten the duration of cough.Treatment of PBB according to the treatment protocol of CVA and asthma does not slow down the progression of the disease.4.PBB affects child’s physical,psychological,and social life quality.