A pediatric disease to keep in mind: diagnostic tools and management of bronchiectasis in pediatric age

Abstract

Bronchiectasis in pediatric age is a heterogeneous disease associated with significant morbidity.The most common medical conditions leading to bronchial damage are previous pneumonia and recurrent lower airway infections followed by underlying diseases such as immune-deficiencies, congenital airway defects, recurrent aspirations and mucociliary clearance disorders.The most frequent symptom is chronic wet cough. The introduction of high-resolution computed tomography (HRCT) has improved the time of diagnosis allowing earlier treatment.However, the term “bronchiectasis” in pediatric age should be used with caution, since some lesions highlighted with HRCT may improve or regress. The use of chest magnetic resonance imaging (MRI) as a radiation-free technique for the assessment and follow-up of lung abnormalities in non-Cystic Fibrosis chronic lung disease is promising.Non-Cystic Fibrosis Bronchiectasis management needs a multi-disciplinary team. Antibiotics and airway clearance techniques (ACT) represent the pillars of treatment even though guidelines in children are lacking. The Azithromycin thanks to its antinflammatory and direct antimicrobial effect could be a new strategy to prevent exacerbations.

Non-CF Bronchiectasis as a Possible Indicator of a Primary Immunodeficiency: Diagnosis, Clinical Course, and Quality of Life in a Pediatric Cohort

“…Patients with and without PID were treated differently according to their underlying condition: Pharmacological and non-pharmacological airway clearance techniques were mostly applied as commonly suggested in NCBE [11,28,31]. However, patients with PID were not consistently treated with inhalation of (hypertonic) saline (▶Fig.…”

“…Children with NCBE need to be diagnosed as early as possible to initiate appropriate treatment because this is pivotal to stabilize the childrensʼ clinical course and quality of life [13,20]. Treatment consists of airway clearing techniques including inhalation of (hypertonic) saline and physiotherapy as well as early identification and treatment of infectious exacerbations [11,28]. Prolonged courses of oral antibiotics and inhalative antibiotics can have a positive effect on pathogen clearance [15,31].…”

Aerodigestive Approach to Chronic Cough in Children

“…Chest computed tomography (CT) scan can be pursued if a higher definition study is needed (17). More specifically, high resolution chest CT should be considered to evaluate for bronchiectasis in children with productive cough outside of viral illnesses, or with positive respiratory cultures, that is non-responsive to traditional antibiotic and asthma therapies (18). …”

“…In children with protracted wet cough that is non-responsive to traditional antibiotic and asthma treatments, high resolution chest CT should be considered to evaluate for bronchiectasis (18). …”

Bronşektazide Klinik Özellikler ve Cerrahi Tedavinin Sonuçları

“…Yeterli akciğer fonksiyonları için en az iki lob veya altısegment korunmalıdır 9,14,15 . Silindirik olmayan hastalık, balgam kültürü ile kanıtlanmış psödomonas enfeksiyonu ve lokalize olmayan hastalık bronşektazinin cerrahi tedavisi için göreceli kontrendikasyonları oluşturmaktadır 10 . Multisegmental ve iki taraflı tutulumda cerrahi tartışmalıdır.…”