OVERVIEW

What is persistent bacterial bronchitis?

Persistent bacterial bronchitis is a prolonged inflammation of the bronchial lining caused by bacterial infection. The main pathogens responsible include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. It can be effectively cured with a full course of sensitive antibiotic treatment. However, if left untreated, persistent bacterial bronchitis may lead to chronic suppurative lung disease and bronchiectasis, potentially causing chronic hypoxia in children and affecting their growth and development.

Is persistent bacterial bronchitis common? How many people are affected?

Persistent bacterial bronchitis is increasingly recognized as a major cause of chronic wet cough in children, particularly those under 5 years old. According to foreign data, it accounts for about 40% of pediatric respiratory specialist visits, but relevant domestic statistics are lacking.

Is persistent bacterial bronchitis contagious?

Possibly. The pathogens causing persistent bacterial bronchitis, such as Haemophilus influenzae, can spread through droplets or direct contact from an infected individual to a susceptible one. However, its contagiousness is relatively low, so excessive concern is unnecessary.

SYMPTOMS

What are the manifestations of persistent bacterial bronchitis?

Cough and sputum production are the main symptoms of persistent bacterial bronchitis, with the cough lasting for an extended period, at least 4 weeks. Patients often feel they have a lot of phlegm, characterized by persistent wet coughs, which can occur at any time—morning, evening, or daytime—without a specific pattern.

Does persistent bacterial bronchitis always cause fever?

Not necessarily. Persistent bacterial bronchitis may not present with fever, manifesting primarily as a persistent wet cough, though fever can also accompany the condition.

Can persistent bacterial bronchitis cause wheezing?

Yes, it can. Inflammatory exudation in the bronchial lining may narrow the airway, leading to wheezing. However, not all cases of persistent bacterial bronchitis involve wheezing.

Can persistent bacterial bronchitis develop into other diseases?

Persistent bacterial bronchitis may progress and be associated with conditions such as chronic suppurative lung disease, bronchiectasis, cystic fibrosis, or tracheomalacia.

CAUSES

How does persistent bacterial bronchitis occur?

When viral infections cause damage to respiratory epithelial cells, or factors such as immune dysfunction and airway malformations impair the normal mucosal surface morphology and mucociliary clearance function, persistent bacterial colonization and biofilm formation occur. This leads to ongoing airway inflammation, ultimately resulting in the development of persistent bacterial bronchitis.

At what age is persistent bacterial bronchitis most common?

It is more frequently seen in children under 5 years old.

DIAGNOSIS

How is persistent bacterial bronchitis diagnosed?

• Chronic wet cough (with phlegm) lasting more than 4 weeks;
• Positive bacterial culture from bronchoalveolar lavage fluid (or exclusion of other diseases causing chronic sputum production);
• Effective response to 2 weeks of antibiotic treatment.

What tests might be needed when persistent bacterial bronchitis is suspected?

• Fiberoptic bronchoscopy to obtain bronchoalveolar lavage fluid for bacterial culture is the most valuable, but it is not always necessary and can be confirmed by diagnostic treatment feedback.
• Fiberoptic bronchoscopy is more commonly used for recurrent persistent bacterial bronchitis, chronic suppurative lung disease, or patients with suboptimal response to empirical antibiotic treatment. These patients may also require high-resolution CT for further evaluation.

What diseases should persistent bacterial bronchitis be differentiated from?

Bronchial asthma, bronchial foreign body, upper airway cough syndrome, bronchiolitis obliterans, etc.

TREATMENT

Which department should I visit if I suspect persistent bacterial bronchitis?

Visit a pediatric respiratory specialist; if unavailable, go to the pediatric internal medicine department.

How should antibiotics be chosen for persistent bacterial bronchitis, and how long is the treatment?

The primary treatment is antibiotic therapy targeting the main pathogens causing persistent bacterial bronchitis. Options include most second- and third-generation cephalosporins and compound metronidazole, with amoxicillin-clavulanate potassium usually being the first choice.

If bacterial culture is performed, sensitive antibiotics can be selected based on the drug susceptibility test. Additionally, due to the lack of studies proving the effectiveness of azithromycin for chronic wet cough and concerns about increasing resistance of Streptococcus pneumoniae and Haemophilus influenzae to macrolides, azithromycin is not recommended for treating chronic wet cough.

A longer course of antibiotics is required, typically 2–4 weeks. Shorter courses often lead to relapse.

Can persistent bacterial bronchitis be completely cured?

Early diagnosis and proper treatment can lead to a cure. However, delayed or improper treatment may result in irreversible damage.

Can persistent bacterial bronchitis recur after recovery?

Yes. Most cases can be cured with a full course of sensitive antibiotics, but a small number may recur. If episodes recur more than three times within a year, it is termed "recurrent persistent bacterial bronchitis." Such patients require detailed evaluation, including bronchoscopy, high-resolution CT, and a comprehensive immune function assessment.

DIET & LIFESTYLE

What should children with protracted bacterial bronchitis pay attention to in daily life?

• Avoid crowded places
• Maintain a light diet with balanced nutrition
• Keep warm and ensure proper ventilation
• Encourage physical activity when possible

PREVENTION

Is there any way to prevent protracted bacterial bronchitis?

Currently, there are no particularly effective medications to enhance immunity that can help. Prevention mainly focuses on daily life care, such as:

• Develop the habit of handwashing in children to reduce the chance of pathogen infection through hand hygiene;
• Vaccinate on schedule, including both Category I and II vaccines, especially influenza vaccines, pneumococcal vaccines, HIB vaccines, etc., as these are common pathogens causing infections in children;
• Try to avoid taking children to crowded places;
• Maintain a balanced diet and engage in reasonable outdoor activities and exercise;
• Adults around children should quit smoking to avoid secondhand smoke irritation.