Pediatric Bronchitis Workup

  • Author: Patrick L Carolan, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Mar 29, 2011
 

Approach Considerations

For maximal cost-effectiveness, diagnostic laboratory tests for bronchitis should be performed in a stepwise manner. Patients with uncomplicated acute respiratory illness who are cared for in an outpatient setting need little, if any, laboratory evaluation.

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Testing in Hospitalized Children

For hospitalized children, serum C-reactive protein screen, respiratory culture, rapid diagnostic studies, and serum cold agglutinin testing (at the appropriate age) help to classify whether the infection is caused by bacteria, atypical pathogens (eg, Chlamydia pneumoniae, Mycoplasma pneumoniae), or viruses. Obtain a blood or sputum culture if antibiotic therapy is under consideration.

For the child admitted to the hospital with a possible chlamydial, mycoplasmal, or viral lower respiratory tract infection for which specific therapy is considered, test nasopharyngeal secretions for these pathogens, using antigen or polymerase chain reaction testing for Chlamydia species and respiratory syncytial, parainfluenza, and influenza viruses or viral culture. Results will guide appropriate antimicrobial selection.

For the child who has been intubated, collect a specimen of deep respiratory secretions for Gram stain, chlamydial and viral antigen assays, and bacterial and viral cultures.

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Asthma Testing

A clinical response to daily high-dose oral corticosteroids may be considered as a diagnostic and therapeutic trial to confirm asthma. Evidence of reversible airflow obstruction revealed by pulmonary function testing confirms the diagnosis of asthma.

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Cystic Fibrosis Testing

A negative sweat test result using pilocarpine iontophoresis should exclude cystic fibrosis. Many states are now using CFTR mutational analyses in newborn screening programs.

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Immunodeficiency Testing

For children in whom immunodeficiency is suspected, measurement of total serum immunoglobulins, immunoglobulin G (IgG) subclasses, and specific antibody production is recommended to establish the diagnosis.

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Chest Radiography

Chest films generally appear normal in patients with uncomplicated bronchitis. Abnormal findings are minimal and may include atelectasis, hyperinflation, and peribronchial thickening. Focal consolidation is not usually present. These findings are similar to the radiographic findings in patients with asthma. Radiographic findings may help exclude other diseases or complications, particularly when abnormalities in either vital signs or pulse oximetry findings are present.

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Pulmonary Function Testing

Pulmonary function tests may show airflow obstruction that is reversible with bronchodilators. Bronchial challenge, such as with exercise or with histamine or methacholine exposure, may demonstrate the airway hyperreactivity characteristic of asthma.

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Bronchoscopy

On fiberoptic bronchoscopy, a diagnosis of chronic bronchitis is suggested if the airways appear erythematous and friable. Bronchoalveolar lavage may be useful in establishing an infectious cause. Bronchoalveolar lavage may reveal numerous monocytic or polymorphonuclear inflammatory cells. In children with chronic aspiration of gastric contents, lipids may be present within macrophages.

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Contributor Information and Disclosures
Author

Patrick L Carolan, MD  Adjunct Associate Professor, Departments of Pediatrics, Family Practice, and Community Health, University of Minnesota Medical School; Medical Director of Minnesota Sudden Infant Death Center; Attending Staff, Department of Emergency Services, Children's Hospitals and Clinics of Minnesota

Patrick L Carolan, MD is a member of the following medical societies: American Academy of Pediatrics and International Society of SIDS Researchers

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas Scanlin, MD  Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Charles Callahan, DO  Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

  1. Horner CC, Bacharier LB. Diagnosis and management of asthma in preschool and school-age children: focus on the 2007 NAEPP Guidelines. Curr Opin Pulm Med. Jan 2009;15(1):52-6. [Medline].

  2. Brodzinski H, Ruddy RM. Review of new and newly discovered respiratory tract viruses in children. Pediatr Emerg Care. May 2009;25(5):352-60; quiz 361-3. [Medline].

  3. Miron D, Srugo I, Kra-Oz Z, Keness Y, Wolf D, Amirav I, et al. Sole pathogen in acute bronchiolitis: is there a role for other organisms apart from respiratory syncytial virus?. Pediatr Infect Dis J. Jan 2010;29(1):e7-e10. [Medline].

  4. Voynow JA, Rubin BK. Mucins, mucus, and sputum. Chest. Feb 2009;135(2):505-12. [Medline].

  5. Mall MA. Role of cilia, mucus, and airway surface liquid in mucociliary dysfunction: lessons from mouse models. J Aerosol Med Pulm Drug Deliv. Mar 2008;21(1):13-24. [Medline].

  6. Kreindler JL, Jackson AD, Kemp PA, Bridges RJ, Danahay H. Inhibition of chloride secretion in human bronchial epithelial cells by cigarette smoke extract. Am J Physiol Lung Cell Mol Physiol. May 2005;288(5):L894-902. [Medline]. [Full Text].

  7. McConnell R, Berhane K, Gilliland F, Molitor J, Thomas D, Lurmann F, et al. Prospective study of air pollution and bronchitic symptoms in children with asthma. Am J Respir Crit Care Med. Oct 1 2003;168(7):790-7. [Medline]. [Full Text].

  8. Brieu N, Guyon G, Rodière M, Segondy M, Foulongne V. Human bocavirus infection in children with respiratory tract disease. Pediatr Infect Dis J. Nov 2008;27(11):969-73. [Medline].

  9. Schildgen O, Müller A, Allander T, Mackay IM, Völz S, Kupfer B, et al. Human bocavirus: passenger or pathogen in acute respiratory tract infections?. Clin Microbiol Rev. Apr 2008;21(2):291-304, table of contents. [Medline]. [Full Text].

  10. Allander T. Human bocavirus. J Clin Virol. Jan 2008;41(1):29-33. [Medline].

  11. [Best Evidence] Koehoorn M, Karr CJ, Demers PA, Lencar C, Tamburic L, Brauer M. Descriptive epidemiological features of bronchiolitis in a population-based cohort. Pediatrics. Dec 2008;122(6):1196-203. [Medline].

  12. Tsai CH, Huang JH, Hwang BF, Lee YL. Household environmental tobacco smoke and risks of asthma, wheeze and bronchitic symptoms among children in Taiwan. Respir Res. Jan 29 2010;11:11. [Medline]. [Full Text].

  13. Zaccagni HJ, Kirchner L, Brownlee J, Bloom K. A case of plastic bronchitis presenting 9 years after Fontan. Pediatr Cardiol. Jan 2008;29(1):157-9. [Medline].

  14. Zahorec M, Kovacikova L, Martanovic P, Skrak P, Kunovsky P. The use of high-frequency jet ventilation for removal of obstructing casts in patients with plastic bronchitis. Pediatr Crit Care Med. May 2009;10(3):e34-6. [Medline].

  15. Shah SS, Drinkwater DC, Christian KG. Plastic bronchitis: is thoracic duct ligation a real surgical option?. Ann Thorac Surg. Jun 2006;81(6):2281-3. [Medline].

  16. US Department of Health and Human Services. Vital and Health Statistics. National Ambulatory Medical Care Survey: 1991 Summary. Series 13: Data from the National Health Survey No. 116. DHHS Publication; May 1994.

  17. Weigl JA, Puppe W, Belke O, Neusüss J, Bagci F, Schmitt HJ. The descriptive epidemiology of severe lower respiratory tract infections in children in Kiel, Germany. Klin Padiatr. Sep-Oct 2005;217(5):259-67. [Medline].

  18. Brunton S, Carmichael BP, Colgan R, Feeney AS, Fendrick AM, Quintiliani R, et al. Acute exacerbation of chronic bronchitis: a primary care consensus guideline. Am J Manag Care. Oct 2004;10(10):689-96. [Medline].

  19. Stiehm ER. The four most common pediatric immunodeficiencies. J Immunotoxicol. Apr 2008;5(2):227-34. [Medline].

  20. Ozkan H, Atlihan F, Genel F, Targan S, Gunvar T. IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage. J Investig Allergol Clin Immunol. 2005;15(1):69-74. [Medline].

  21. Kainulainen L, Nikoskelainen J, Ruuskanen O. Diagnostic findings in 95 Finnish patients with common variable immunodeficiency. J Clin Immunol. Mar 2001;21(2):145-9. [Medline].

  22. Kamin W, Maydannik VG, Malek FA, Kieser M. Efficacy and tolerability of EPs 7630 in patients (aged 6-18 years old) with acute bronchitis. Acta Paediatr. Apr 2010;99(4):537-43. [Medline]. [Full Text].

  23. Kamin W, Maydannik V, Malek FA, Kieser M. Efficacy and tolerability of EPs 7630 in children and adolescents with acute bronchitis - a randomized, double-blind, placebo-controlled multicenter trial with a herbal drug preparation from Pelargonium sidoides roots. Int J Clin Pharmacol Ther. Mar 2010;48(3):184-91. [Medline].

 
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Normal airway color and architecture (in a child with mild tracheomalacia).
Airway of a child with chronic bronchitis shows erythema, loss of normal architecture, and swelling.
 
 
 
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