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خرید پکیج
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Prevalence of symptoms and signs related to bronchiectasis in children

Prevalence of symptoms and signs related to bronchiectasis in children
  Frequency among children with bronchiectasis[1] Comments Odds ratio for predicting bronchiectasis*[2] (95% CI)
Symptom
Chronic wet or productive cough Very common Present in up to 50% of children with bronchiectasis in resource-rich settings and up to 100% in resource-limited settings or certain indigenous populations 527 (45.4-6102)
Recurrent protracted bacterial bronchitis Unknown (but probably somewhat common) Diagnosis is made based on clinical criteria; management requires follow-up through resolution  18.4 (1.0-349.7)
Recurrent or previous pneumonia Very common Particularly common in low-resource populations (up to 100% of cohort) 22.8 (1.2-424.3)
Wheeze or reversible airway obstruction Common (10 to 66%) Likely differs from classic asthma; manage based on clinical response to therapy    
Hemoptysis Uncommon Suggests advanced disease  
Chest pain Uncommon Symptom is typically intermittent rather than chronic  
Dyspnea/exertional dyspnea Highly variable among different populations Common in low-resource settings or when diagnosis is delayed in more severe disease 4.3 (0.2-109.7)
Sinusitis/otitis problems Highly variable among different populations Often associated with underlying immunodeficiency[3]  
Faltering growth Uncommon Common in low-resource settings or when diagnosis is delayed  
Feeding difficulties Uncommon Suggests possibility of recurrent small-volume aspiration  22.8 (1.2-424.3)
Signs
Digital clubbing Highly variable among different populations Uncommon in resource-rich settings, but found in up to 70% of children in low-resource settings or when diagnosis is delayed 7.5 (0.3-161.5)
Chest deformity Common (15 to 30%) Includes hyperinflation, Harrison sulci, pectus carinatum 4.3 (0.2-109.7)
Differential airway sounds (on chest auscultation) Unknown More likely with focal disease or during an exacerbation 7.5 (0.3-161.5)
Crackles Uncommon More common prior to antibiotic treatment, during an exacerbation, when disease is severe, or in patients with certain underlying diseases such as bronchiolitis obliterans 10.8 (0.5-218.9)
Basic tests
Chest radiograph abnormal Uncommon Low sensitivity to detect bronchiectasis 41.6 (2.3-750)
FEV1 percent predicted (median) 52 to 95% Median FEV1 is lower in resource-limited settings or when diagnosis is delayed 4.3 (0.2-109.7)
FVC percent predicted (median) 58 to 96% Median FVC is lower in resource-limited settings or when diagnosis is delayed Not stated
Bold text indicates strongest predictors of bronchiectasis compared with self-limited cough*.
FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity.
* For each symptom/sign, the odds ratio of having bronchiectasis is compared with children whose cough resolved without any specific treatment, based on a study involving 326 Australian children with chronic cough newly referred to a respiratory pediatrician[2].
¶ In a study from Turkey, otitis/sinusitis was present in 64% of children with bronchiectasis. The high prevalence of otitis/sinusitis in this study is from a population in Turkey with very high rates of consanguinity (present in 59.4% of children with bronchiectasis)[3] and associated risk of rare primary immunodeficiency disorders.
References:
  1. Chang AB, Bush A, Grimwood K. Bronchiectasis in children: Diagnosis and Treatment. Lancet 2018; 392:866.
  2. Chang AB, Robertson CF, van Asperen PP, et al. Children with chronic cough: when is watchful waiting appropriate? Development of likelihood ratios for assessing children with chronic cough. Chest 2015; 147:745.
  3. Satirer O, Mete YA, Emiralioglu N, et al. A review of the etiology and clinical presentation of non-cystic fibrosis bronchiectasis: A tertiary care experience. Respir Med 2018; 137:35.
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