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We write with regard to the retrospective chart review by Donnelly published recently in Thorax.1 The review covers a 5 year period and it is presented as a cross-sectional survey of their personal practice of children with persistent bacterial bronchitis. We are unsure how often the patients were seen over the time of the review and it does not examine outcomes longitudinally.
We agree that there is a lack of clarity regarding the definition of chronic bronchitis. However, like all diagnoses of exclusion, it is a difficult diagnosis to make. The definition of chronic bronchitis in adults is more specific: “the presence of chronic productive cough for 3 months in each of two successive years and a patient under whom other causes of chronic cough have been excluded”.2 Comments regarding the diagnosis from two recently published paediatric respiratory text books are illuminating. In the first3 the adult definition of chronic bronchitis is given but “whether this definition can be applied to childhood chronic bronchitis remains unclear” and “it has the potential to divert the paediatrician from detecting a more specific respiratory condition”. The authors of the chapter suggest that: “The diagnosis of chronic bronchitis should occur in two phases. The first is consideration and identification of several well defined respiratory disorders according to a staged management protocol. The second but simultaneous phase is elimination or modification of exogenous factors that produce or maintain the child’s illness.” The second paediatric text4 also notes that “the definition of chronic bronchitis in children is less clear …”.
Our concern with this paper, based on our own experience, is that the label of “chronic bronchitis” is given to children without adequate exclusion of other diagnoses. We acknowledge that our centres may differ because of the referral pattern, with most …
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