Pediatric bronchiectasis-the importance of early diagnosis of children across the chronic wet cough spectrum.

Cohort studies show that lung function trajectories generally track across the life course, with sub-optimal peak lung function linked to earlier onset and higher risk of multimorbidity and all-cause mortality. Early-life exposures are critical determinants of long-term respiratory health. Systematic reviews identify childhood bronchitis, particularly when frequent, as increasing the risk of a low lung function trajectory and accelerated decline in adulthood. Early recognition and management of chronic wet cough is therefore essential. Chronic wet cough is the hallmark symptom of pediatric bronchiectasis, and delayed diagnosis is associated with lower spirometry values. Bronchiectasis in children is defined as a clinical syndrome of persistent wet/productive cough with pediatric-defined abnormal bronchial dilatation on chest high-resolution computed tomography (cHRCT). The global burden, economic costs, and quality-of-life impacts for children and caregivers are increasingly recognised. Importantly, with timely and optimal management, lung function in affected children can stabilise or improve. Most chronic wet cough reflects ongoing endobronchial infection, where early effective treatment may halt progression to bronchiectasis. In some cases, bronchiectasis may be reversible. A greater likelihood of radiographic resolution is associated with younger age at diagnosis, milder radiographic severity, fewer exacerbations requiring intravenous antibiotics, and absence of Pseudomonas aeruginosa infection. Earlier diagnosis depends on recognising chronic wet cough, raising community and health professional awareness, and ensuring health systems support timely referral to specialists with access to age-appropriate diagnostic tools such as HRCT. Yet pediatric bronchiectasis remains neglected, with frequent diagnostic errors and delays. Greater community attention to chronic wet cough represents an opportunity to reduce disease burden, lessen economic impacts on families and health systems, and optimise lung function trajectories and outcomes across the life course. The objective of this article is to examine strategies for earlier recognition and management of chronic wet cough in children, with a focus on prevention and potential reversal of bronchiectasis, and long-term optimisation of lung function trajectories.