Definition and clinical features of protracted bacterial bronchitis in children

Protracted bacterial bronchitis (also called persistent bacterial bronchitis) is a productive (wet or moist) cough in children that lasts for 4 weeks or longer and responds to 2 to 4 weeks of appropriate antibiotic therapyChang, 2017Ruffles, 2021Lung Foundation Australia, 2022.

Note: Protracted bacterial bronchitis is a wet or moist cough that lasts for 4 weeks or longer and responds to 2 to 4 weeks of appropriate antibiotic therapy.

Protracted bacterial bronchitis can occur in children of all ages but most commonly occurs in children 5 years or younger. Children with 3 or more episodes of protracted bacterial bronchitis per year may have an increased risk of developing bronchiectasisLung Foundation Australia, 2022Ruffles, 2021Wurzel, 2016.

Note: Protracted bacterial bronchitis may increase the risk of developing bronchiectasis.

For children who have had a cough for 4 weeks or longer, a thorough history and clinical examination are essential to exclude other causes of chronic cough in children before considering antibiotic therapy for protracted bacterial bronchitis. In particularLung Foundation Australia, 2022:

  • asthma – consider if the child has wheeze, shortness of breath and night or early morning cough. For children 6 years or older, see Approach to diagnosis of asthma; for children 5 years or younger, see Assessment of wheeze and asthma in children 5 years or younger
  • bronchiectasis – consider if there is persistent parenchymal change on chest X-rays over time, hyperinflation, chest wall deformity, abnormal growth or development, or clubbing of the fingers; for further detail on diagnosis, see Bronchiectasis
  • recurrent aspiration – consider if the child chokes or coughs during feeds
  • retained inhaled foreign body – consider if the cough was sudden in onset (particularly if cough started while the child was eating or playing with small objects); urgently refer to a paediatrician, or an ear, nose and throat or a respiratory specialist.
Note: A diagnosis of protracted bacterial bronchitis is excluded if the child’s cough is solely dry.

For clinical features of protracted bacterial bronchitis in children, see Clinical features of protracted bacterial bronchitis in children. The hallmark feature is a chronic productive (wet or moist) cough. A diagnosis of protracted bacterial bronchitis is excluded if the child’s cough is solely dry. If the diagnosis is uncertain, seek expert advice from a paediatrician.

For an overview of diagnosis and general management of cough, see Cough in children. For detailed advice on diagnosis and assessment, see the Cough in Children and Adults Diagnosis and Assessment (CICADA) guidelines.

Figure 1. Clinical features of protracted bacterial bronchitis in children. Chang, Oppenheimer, , 2016Chang, Upham, , 2016Di Filippo, 2018

In a child with protracted bacterial bronchitis, the cough:

  • is productive (wet or moist), often with a ‘rattly’ sound on chest examination
  • lasts for 4 weeks or longer
  • occurs on most days, can occur at night and worsens when lying flat
  • is an isolated symptom; the child is otherwise well and has no indicators of alternate diagnoses (eg inhaled foreign body, cystic fibrosis, tuberculosis)
  • can cause shortness of breath during coughing episodes but not at other times.