Protracted Bacterial Bronchitis PBB 

PBB is increasingly being considered to be one of the common causes of chronic wet cough, particularly in young children (<5 years of age) in western countries for the past few years. Identification and treatment of PBB is important because it may be a precursor to Chronic suppurative lung disease in children.  

Diagnosis — PBB is usually diagnosed based on clinical criteria

  • Chronic wet cough (duration at least four weeks
  • No other symptoms or signs of other causes
  • No evidence of an alternative diagnosis after a standard evaluation (spirometry/impulse oscillometry and Chest X-ray)
  • Resolution of the cough after a two-week course of appropriate antibiotics

PBB is caused by typical respiratory pathogens, such as H. influenzaeStreptococcus pneumoniae, and Moraxella catarrhalis. Bronchoscopy is not required for the diagnosis but, if performed, reveals mucopurulent discharge in the bronchi. Most of these children may be wrongly diagnosed as asthma and treated with inhaled steroids with no response. PBB usually does not have wheeze in chest but might a few rattles because of secretions in airway. The treatment is 2-3 weeks of co-amoxyclav. 

 PBB has not been documented commonly in the Indian set up possibly because of lack of awareness of the disease and rampant use of antibiotics in viral diseases. 

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