Chronic Suppurative Lung Disease and Bronchiectasis in Children and Adolescents

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Background

There is an established belief that adult respiratory health to a large extent originates early in life. This is especially true for atopic asthma where large multicentre population studies indicate that adult lung function and susceptibility to chronic obstructive pulmonary disease (COPD) is partly determined in childhood.
In children recurrent airways bacterial infections may result in chronic respiratory symptoms that persist until adulthood. In developed countries a relevant cause of recurrent to persistent cough in children or adolescents is cystic fibrosis (CF), but other genetic or acquired conditions associated with early childhood respiratory infections as initiating events have been increasingly described. Some of these have been associated with the development of COPD at older ages. Most studies sustain the hypothesis that the primum movens is airways bacterial colonization of the airway biofilm, and that progressive anatomical tissue damage including chronic endobronchial suppuration and bronchiectasis ultimately develops. At that point lung function loss may become irreversible. Major conditions include protracted bacterial bronchitis, recurrent pneumonia, and non-CF bronchiectasis.
Aim of this Section is to provide an update on chronic suppurative lung disease and bronchiectasis in children and adolescents. We will focus the readers’ attention on some issues that are still poor understood or partly lacking, such as the prevalence of the disease both in affluent and non affluent countries, its clinical spectrum and the immunological mechanisms underlying it in various settings. Since early identification of clinical features and prompt referral to tertiary centres are essential in order to improve outcome and reduce pulmonary function decline, etiology of the disorder will be accurately defined and diagnostic steps outlined. Pulmonary function evaluation including spirometry and even more sophisticated techniques will also be updated since it tracks the disease progression and may result in prompt referral for modifying the management. Treatment including airways clearance techniques, especially daily respiratory physiotherapy, and inhaled and/or systemic antibiotics is generally derived from the therapeutic strategy adopted in CF. Nevertheless it has a considerable impact on the clinical course of the disease and significantly affects its final outcome. Finally, as quality of life is getting more importance than in the past as a relevant issue that takes into account the individual needs of the patients, an updated review on the tools used for its evaluation will be presented.

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