https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37191 Wed 30 Aug 2023 15:39:56 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29719 4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1ß signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.]]> Wed 23 Feb 2022 16:05:45 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:33991 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? Methods: We used the CHEST Expert Cough Panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus. Results: Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies. Conclusions: There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.]]> Tue 29 Jan 2019 15:55:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45975 Is there evidence of clinically important treatment effects for non-pharmacological therapies in cough treatment for patients with bronchiectasis?" Populations selected were all patients with bronchiectasis due to CF or non-CF bronchiectasis. The interventions explored were the non-pharmacological airway clearance therapies. The comparison populations included those receiving standard therapy and/or placebo. Clinically important outcomes that were explored were exacerbation rates, quality of life, hospitalizations, and mortality. Results: In both CF and non-CF bronchiectasis, there were systematic reviews and overviews of systematic reviews identified. Despite these findings, there were no large randomized controlled trials that explored the impact of airway clearance on exacerbation rates, quality of life, hospitalizations, or mortality. Conclusions: Although the cough panel was not able to make recommendations, they have made consensus-based suggestions and provided direction for future studies to fill the gaps in knowledge.]]> Tue 08 Nov 2022 14:39:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32992 Haemophilus influenzae (NTHi), and expression of genes involved in various inflammatory pathways was assessed. Result: NTHi induced production of large amounts of IL-1ß, IL-6, and IL-8 in adult-control BAL cells, ho wever BAL cells from PBB airways appeared refractory to NTHi stimulation. BAL cells from PBB and bronchiectasis showed differential expression of several genes relative to control cells, including CCL20, MARCO, CCL24, IL-10, PPAR-¿, CD200R, TREM2, RelB. Expression of genes involved in resolution of inflammation and anti-inflammation response, such as CD200R and IL-10, was associated with the number of pathogenic bacteria found in the airways. Conclusion: In summary, we have shown that the expression of genes related to macrophage function and resolution of inflammation are similar in PBB and bronchiectasis. Lung immune cell dysfunction in PBB and bronchiectasis may contribute to poor bacterial clearance and prolonged resolution of inflammation.]]> Thu 28 Oct 2021 13:03:20 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29360 Thu 27 Jan 2022 15:58:57 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:55045 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. Changes in management as a result of this statement: ; Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. ; High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. ; Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. ; Early and effective treatment of chronic wet/productive cough in children is critical. ; Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. ; If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.]]> Thu 04 Apr 2024 13:51:48 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:13277 Sat 24 Mar 2018 08:15:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20635 Sat 24 Mar 2018 07:55:47 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20295 Sat 24 Mar 2018 07:55:14 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29176 Sat 24 Mar 2018 07:35:44 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:4817 Sat 24 Mar 2018 07:18:46 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:23311 Sat 24 Mar 2018 07:13:31 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32658 Mon 23 Sep 2019 11:23:10 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46104 adj = 9.6, 95% CI: 1.8–50.1) and the presence of Haemophilus influenzae in the BAL (OR_adj = 5.1, 95% CI: 1.4–19.1). Clinician-diagnosed asthma at final follow-up was present in 27.1% of children with PBB. A significant BDR (FEV₁ improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen-specific IgE (OR_adj = 14.8, 95% CI: 2.2–100.8) at baseline and bronchomalacia (OR_adj = 5.9, 95% CI: 1.2–29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. Conclusion: As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required.]]> Mon 21 Nov 2022 09:17:31 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32993 Haemophilus influenzae (NTHi). The mechanisms responsible for IL-1-driven inflammation in PBB are poorly understood. We hypothesised that the inflammation in PBB involves the NLRP3 and/or AIM2 inflammasome/IL-1ß axis. Lung macrophages obtained from bronchoalveolar lavage (BAL), peripheral blood mononuclear cells (PBMCs), blood monocytes and monocyte-derived macrophages from patients with PBB and age-matched healthy controls were cultured in control medium or exposed to live NTHi. In healthy adult PBMCs, CD14⁺ monocytes contributed to 95% of total IL-1ß-producing cells upon NTHi stimulation. Stimulation of PBB PBMCs with NTHi significantly increased IL-1ß expression (p<0.001), but decreased NLRC4 expression (p<0.01). NTHi induced IL-1ß secretion in PBMCs from both healthy controls and patients with recurrent PBB. This was inhibited by Z-YVAD-FMK (a caspase-1 selective inhibitor) and by MCC950 (a NLRP3 selective inhibitor). In PBB BAL macrophages inflammasome complexes were visualised as fluorescence specks of NLRP3 or AIM2 colocalised with cleaved caspase-1 and cleaved IL-1ß. NTHi stimulation induced formation of specks of cleaved IL-1ß, NLRP3 and AIM2 in PBMCs, blood monocytes and monocyte-derived macrophages. We conclude that both the NLRP3 and AIM2 inflammasomes probably drive the IL-1ß-dominated inflammation in PBB.]]> Mon 08 Jul 2019 11:29:52 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:36789 Mon 06 Jul 2020 11:38:40 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35554 Prevotella species. Alpha diversity was unrelated to bacterial biomass, culture of recognized respiratory pathogens, or inflammatory markers. Conclusions: Neutrophilic inflammation in children with PBB was associated with multiple BAL microbiota profiles. Significant associations between inflammatory markers and bacterial biomass, but not alpha diversity, suggest that inflammation in children with PBB is not driven by single pathogenic species. Understanding the role of the entire respiratory microbiota in PBB pathogenesis may be important to determining whether bacteria other than the recognized pathogens contribute to disease recurrence and progression to bronchiectasis.]]> Fri 31 Jan 2020 16:15:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49491 4-weeks duration) and without underlying lung disease: (1) who do not havegastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) withgastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with orwithout gastrointestinal GER symptoms, what GER-based therapies should be used and forhow long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteriabest determine GERD as the cause of the cough?METHODS:We used the CHEST Expert Cough Panel’s protocol and American College ofChest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recom-mendations Assessment, Development and Evaluation) framework. Delphi methodology wasused to obtain consensus.RESULTS:Few randomized controlled trials addressed thefirst two questions and noneaddressed the other two. The single meta-analysis (two randomized controlled trials)showed no significant difference between the groups (any intervention for GERDvs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93;P¼.78). Proton pumpinhibitors (vs placebo) caused increased serious adverse events. Qualitative data fromexisting CHEST cough systematic reviews were consistent with two international GERDguidelines.CONCLUSIONS:The panelists endorsed that: (1) treatment(s) for GERD should not be usedwhen there are no clinical features of GERD; and (2) pediatric GERD guidelines should beused to guide treatment and investigations.]]> Fri 19 May 2023 09:55:59 AEST ]]>