'Suppurative lung disease' in children

A chronic neutrophil dominated bronchitis also known variously as PBB and CSLD is relatively common in childhood. There are numerous risk factors that may contribute to the development of a chronic bronchitis [inc viral LRTIs, malacia, aspiration, poorly controlled asthma etc.]. In most cases a specific significant on-going risk factor such as CF is not identified. It is under-diagnosed due to lack of awareness (if you do not know something exists you will never diagnose it). It is commonly mis-diagnosed as 'asthma' or 'recurrent chest infections'. Diagnosis is based on pattern recognition and response to treatment analogous to accurate diagnosis of asthma. Response to treatment must be dramatic and unequivocal to make a definite diagnosis. Beware regression to the mean PBB is a biofilm disease leading to challenges in treatment. A PBB is the cause of most cases of 'bronchiectasis'. Bronchiectasis is a radiological or pathological appearance, not a disease. Most cases are curable in the absence of a major underlying risk factor such as cystic fibrosis, PCD or significant immunodeficiency. Hence bronchiectasis is a largely preventable radiological appearance.