Suppurative lung disease are associated with chronic, wet-sounding cough in children who are unable to clear their airways off secretions. This can be due to an inherent problem where the secretions are so thick that they cannot be easily removed (cystic fibrosis), or due to airway dilatation (bronchiectasis), or genetic problems in airway clearing mechanisms of the airway (Primary Ciliary dyskinesia) or in chronic wet cough due to infection (protracted bacterial bronchitis).

What are the symptoms of suppurative lung disease?

Chronic, wet cough is the most common symptom of suppurative lung disease. These children are often found coughing out thick mucus. Cough may last for more than 4 weeks to months.
Repeated lung infections or pneumonia is common due to accumulation of secretions that leads to dessication in the airway.
Chronic obstruction with thick mucus leads decreased lung function and requires prolonged care.

What tests are done to diagnose suppurative lung disease?

Radiological imaging (chest Xrays and CT scan) demonstrate thickened dilated airways suggestive of bronchiectasis. Mucus plugs and airway obstruction can also be visualized by airway.
These children may require flexible bronchoscopy and bronchoalveolar lavage to aspirate out mucus and test it for infections.
Sweat chloride test and genetic tests can be done for cystic fibrosis. For primary ciliary dyskinesia, decreased nasal or exhaled nitric oxide is a good screening test.

How do we treat these children?

• Airway clearance techniques: These children constantly require help with mucus clearance. Medications like hypertonic saline, anti-DNAse help in thinning of the mucus. Chest physiotherapy helps in expelling out this thinned mucus.
• Antibiotics: Repeated lung infections require antibiotics. Sometimes airway is colonized by bacteria that is difficult to eliminate and inhaled antibiotics are given in such cases.
• Chest physiotherapy plays a very important role in management of secretions.