Paeds · respiratory-sleep-and-airway
Bronchiectasis in children
Also known as Paediatric bronchiectasis · Non-cystic fibrosis bronchiectasis · Chronic suppurative lung disease · CSLD · Childhood bronchiectasis
Fellowship guide to bronchiectasis in children — the chronic wet cough that defines it, the chronic suppurative lung disease continuum that precedes it, the vicious cycle that drives it, the HRCT that confirms it, the aetiological work-up that must follow, and the airway-clearance-and-antibiotic management that can reverse early disease and prevent lifelong lung damage.
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Red flags
- A wet or productive cough lasting more than four weeks that keeps returning after antibiotics is chronic suppurative lung disease until proven otherwise, not a run of viruses — it is the earliest and most reversible stage of bronchiectasis
- Digital clubbing, faltering growth, or fixed focal chest signs in a child with chronic cough signal established suppurative lung disease and demand a chest HRCT, not another empirical antibiotic course
- Bronchiectasis in a child is a symptom, not a diagnosis — every child needs a systematic search for a treatable underlying cause such as immunodeficiency, cystic fibrosis, primary ciliary dyskinesia, aspiration, or a retained foreign body
- Pseudomonas aeruginosa cultured from a child with bronchiectasis marks more severe disease and worse lung function and should trigger eradication and specialist referral
- Aboriginal, Torres Strait Islander, Māori, and Pacific children carry among the highest rates of bronchiectasis in the world, and delayed diagnosis in these children is a preventable driver of chronic lung disease
- In early childhood, bronchiectasis diagnosed on HRCT can regress with intensive treatment — early diagnosis is the difference between a reversible and an irreversible airway
Life stages
Care settings
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- Respiratory Medicine
- General and Community Paediatrics
- Chronic suppurative lung disease and bronchiectasis
- Paediatric respiratory and sleep medicine competencies
- Diagnosis, aetiological work-up, and management of childhood bronchiectasis
- Current PREP curriculum — chronic suppurative lung disease and Indigenous child lung health
- Clinical Applications
- Systematic evaluation of the child with chronic wet cough and bronchiectasis
- Long and Short Cases
- Respiratory long case: chronic suppurative lung disease and bronchiectasis
- 1. Good clinical care: Managing complexity and uncertainty
- Respiratory: Evaluates and manages the child with chronic wet cough and bronchiectasis
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Respiratory medicine
- Clinical
- Respiratory assessment and management
- History taking and management planning
- General Pediatrics Content Outline — Respiratory system
- General Pediatrics EPA: Evaluate the child with chronic cough
- Patient Care: Evaluation and management of chronic suppurative lung disease
- Medical Knowledge: Paediatric bronchiectasis and its underlying causes
- Systems-Based Practice: rational use of HRCT, host testing, and multidisciplinary care
- Medical Expert
- Paediatric respiratory assessment and bronchiectasis management
- Pediatrics Core EPA — Assessing and managing chronic wet cough and bronchiectasis
Overview & Definition
A four-year-old is brought back for the fifth time in a year with a "chest infection," and each time a course of antibiotics half-settles a cough that never fully goes away. The parents think he simply catches everything at daycare. The task of the paediatrician is to hear that history differently: a wet cough that persists for weeks and returns the moment antibiotics stop is the sound of an airway that cannot clear itself, and it is the earliest signal on the road to bronchiectasis. [1] [4]
Bronchiectasis is the permanent, abnormal widening of one or more bronchi, driven by chronic infection and inflammation that destroy the airway wall. In children it is confirmed on a chest high-resolution CT, where the dilated bronchus becomes wider than its neighbouring artery. The defining clinical feature, present long before any scan, is a chronic wet or productive cough — a cough that brings up sputum or sounds rattly and moist, lasting more than four weeks. [1] [5]
The single most useful idea for the exam is the continuum. Chronic suppurative lung disease describes the child with a persistent wet cough and lower-airway neutrophilic infection whose HRCT does not yet meet radiological criteria for bronchiectasis. Give that same child time and untreated infection, and the airway dilates into established bronchiectasis. The two conditions are the same disease at different stages, which is why the wet cough — not the scan — is the moment to act. [2] [1]
Framing bronchiectasis this way changes the clinical reflex. Rather than treating each "chest infection" as an isolated event, the paediatrician treats the persistent wet cough as a disease that demands both adequate treatment and a search for why the airway keeps failing. In young children this matters enormously, because early bronchiectasis can regress with intensive care in a way that established, long-standing disease cannot. [1] [4]
References11ShowHide
- [1]Chang AB, Bush A, Grimwood K Bronchiectasis in children: diagnosis and treatment. Lancet, 2018.PMID 30215382
- [2]Chang AB, Bell SC, Torzillo PJ, et al Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust, 2015.PMID 25588439
- [3]Chang AB, Fortescue R, Grimwood K, et al European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J, 2021.PMID 33542057
- [4]Goyal V, Grimwood K, Marchant J, et al Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol, 2016.PMID 26840008
- [5]Redding GJ Bronchiectasis in children. Pediatr Clin North Am, 2009.PMID 19135586
- [6]Lucas JS, Barbato A, Collins SA, et al European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia. Eur Respir J, 2017.PMID 27836958
- [7]Goyal V, Grimwood K, Byrnes CA, et al Amoxicillin-clavulanate versus azithromycin for respiratory exacerbations in children with bronchiectasis (BEST-2): a multicentre, double-blind, non-inferiority, randomised controlled trial. Lancet, 2018.PMID 30241722
- [8]Valery PC, Morris PS, Byrnes CA, et al Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): a multicentre, double-blind, randomised controlled trial. Lancet Respir Med, 2013.PMID 24461664
- [9]Kapur N, Masters IB, Chang AB Longitudinal growth and lung function in pediatric non-cystic fibrosis bronchiectasis: what influences lung function stability? Chest, 2010.PMID 20173055
- [10]Kapur N, Karadag B Differences and similarities in non-cystic fibrosis bronchiectasis between developing and affluent countries. Paediatr Respir Rev, 2011.PMID 21458736
- [11]Chang AB, Boyce NC, Masters IB, et al Bronchoscopic findings in children with non-cystic fibrosis chronic suppurative lung disease. Thorax, 2002.PMID 12403874