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Chronischer Husten – eitrige Atemwegserkrankungen bei Kindern

Chronic cough—suppurative airway diseases in children

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Pädiatrie & Pädologie Aims and scope

Zusammenfassung

Ein chronisch feuchter Husten ist meist Ausdruck einer eitrigen Atemwegserkrankung. Dazu zählen die protrahierte bakterielle Bronchitis (PBB), die chronisch eitrige Atemwegs‑/Lungenkrankheit („chronic suppurative lung disease“, CSLD) und die Bronchiektasie. Verschiedene Endotypen dieser Krankheiten sind bekannt. Die PBB ist definiert als mehrwöchige bronchiale Infektion durch Bakterien, wodurch es zu täglichem feuchtem Husten über mindestens 4 Wochen kommt. Virale Infekte gehen häufig voraus und andere chronische eitrige Atemwegserkrankungen müssen ausgeschlossen werden. Die Diagnose wird primär klinisch gestellt („PBB klinisch“) und eine 2‑ bis 4‑wöchige orale Antibiotikagabe führt bei der Hälfte der Kinder zu einer deutlichen Besserung. Bei den restlichen Kindern soll eine genauere Abklärung mittels Thorax-Röntgenaufnahme, Lungenfunktionsmessung, flexibler Bronchoskopie und bronchoalveolärer Lavage und evtl. weiterer Untersuchungen erfolgen. Die häufigsten nachgewiesenen Bakterien sind Haemophilus influenzae, Moraxella catarrhalis und Streptococcus pneumoniae. Potenzielle weitere Therapieoptionen, die bisher noch nicht ausreichend in Studien für diese Indikation untersucht wurden, sind tägliche Inhalationen mit hyperosmolarer Lösung und verschiedene Formen thorakaler Physiotherapie.

Abstract

Chronic wet cough is in most cases an expression of chronic suppurative airway diseases, such as protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. The PBB is defined as a chronic (several weeks) bronchial infection and inflammation caused by bacteria, the presence of isolated chronic wet cough and the absence of indicators suggestive of other specific chronic airway diseases. Primarily, it is diagnosed clinically (PBB clinical) and the cough resolves only after a prolonged course of appropriate antibiotics. Almost half of the affected children need several courses of antibiotics and many suffer a relapse. In these children, further investigations such as imaging, lung function testing, bronchoscopy, bronchoalveolar lavage and exclusion of alternative conditions are warranted. The most common pathogens found in bronchial secretions of children with PBB are Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumonia. Additional treatment options, which have not yet been sufficiently investigated for these indications are daily inhalation of hyperosmolar solutions and various forms of chest physiotherapy.

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  1. Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, 5620, Schwarzach/Pongau, Österreich

    J. Riedler FERS

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M. Rose, Stuttgart

Erstveröffentlichung in Pneumologe 2018. https://doi.org/10.1007/s10405-018-0219-1

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Riedler, J. Chronischer Husten – eitrige Atemwegserkrankungen bei Kindern . Paediatr. Paedolog. 54, 66–73 (2019). https://doi.org/10.1007/s00608-019-0649-y

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