Guidelines Summary

European Respiratory Society guidelines

The European Respiratory Society (ERS) released guidelines for the management of bronchiectasis in children and adolescents.^[28]Highlights of the guidelines include the following:

The ERS suggests that multidetector chest computed tomography scans with high-resolution CT (HRCT) be used to diagnose bronchiectasis in pediatric patients rather than conventional HRCT.
The suggested CT criterion for abnormal broncho-arterial dilatation in children and adolescents is >0.8 instead of the adult cut-off of >1-1.5.
In pediatric patients with bronchiectasis, the ERS advises against the routine use of inhaled corticosteroids either alone or coupled with long-acting β2-agonists. Inhaled corticosteroids may be of benefit in patients who have eosinophilic airway inflammation.
The ERS recommends against the use of recombinant human DNase and bromhexine in children and adolescents with bronchiectasis. Neither inhaled mannitol nor hypertonic saline should be used routinely.
Children and adolescents should be taught airway clearance techniques (ACT) and receive airway clearance regularly. During acute exacerbations of bronchiectasis, ACT should be performed more frequently.
The ERS recommends a 14-day course of antibiotic therapy for an acute respiratory exacerbation of bronchiectasis in children and adolescents.
Following an initial or new detection of Pseudomonas aeruginosa, the ERS suggests eradication therapy in pediatric patients with bronchiectasis.
For children and adolescents who have recurrent exacerbations of bronchiectasis, the ERS recommends long-term therapy with macrolide antibiotics.

Medication

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Media Gallery

Posteroanterior chest radiograph of a child with bronchiectasis due to chronic aspiration.
CT scan of the chest of a child with bronchiectasis due to chronic aspiration.
Chest radiograph of a child with severe adenoviral pneumonia as an infant. The child has persistent symptoms of cough, congestion, and wheezing.
Bronchoscopic bronchogram of the left lower lobe on a patient with history of adenoviral pneumonia, demonstrating cylindrical and varicose types of bronchiectasis.
Bronchoscopic bronchogram of the right upper lobe of a patient with a history of adenoviral pneumonia, demonstrating saccular bronchiectasis.

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Author

Kristen N Miller, MD Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Attending Physician, Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia

Kristen N Miller, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Marianna M Sockrider, MD, DrPH Professor of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine; Chief of Pulmonary Clinics, Texas Children's Hospital

Marianna M Sockrider, MD, DrPH is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, Harris County Medical Society, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler 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, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Additional Contributors

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

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

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Pauline Fani, MD, to the development and writing of the source article.

Pediatric Bronchiectasis Guidelines

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European Respiratory Society guidelines

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