Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms

Abstract

In children with persistent respiratory symptoms despite regular anti-asthma inhalation treatment, diagnostic investigations to exclude underlying disease are warranted.124 children were prospectively enrolled, and 24-h oesophageal pH measurement and fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) were performed. BAL fluid (BALF) was processed for neutrophil counting and bacterial culture. Inflammation of the respiratory mucosa was assessed.A structural abnormality of the central airways was found in 47% of subjects (40% females). In 19% of subjects, neither anatomical anomalies nor inflamed respiratory mucosa were observed, whereas in 64%, definite macroscopic mucosal inflammation was observed. Inflammation of the respiratory mucosa was associated with a significantly higher percentage of neutrophils in the BALF: median (interquartile range) 48 (14-82)% compared with 7 (0-16)% (p,0.025). A positive BALF culture was found in 62% of the infants with mucosal inflammation compared with 25% in the group without inflammation (p,0.016). 56% of the BALF samples were positive for bacterial culture.In children with persistent respiratory symptoms, nearly half have anatomical anomalies of the central airways. In 62% of the children with mucosal inflammation, a positive BAL culture and a significantly higher percentage of BALF neutrophils were detected.

Trans‐nasal flexible bronchoscopy in wheezing children: Diagnostic yield, impact on therapy, and prevalence of laryngeal cleft

“…Like previous authors, we also found tracheobronchomalacia to be a common anatomic finding in this population . The age range for finding of tracheobronchomalacia was similar to previous report .…”

“…Results of this study are in concordance with previous studies reporting a high rate of anatomic and inflammatory findings on FB performed in children with persistent or atypical wheezing . The rate of a completely normal examination was very low at <12%, which is in the low range of normal examinations reported by others (6.7‐52%) …”

“…Flexible bronchoscopy will identify anatomic abnormalities as well as lower airway inflammation, both causes and exacerbators of wheezing in children. Studies evaluating the yield of FB for infants and children with persistent or atypical wheezing identify anatomic abnormalities in 35‐85% . Tracheobronchomalacia is a common such anatomic abnormality whose identification as the cause of wheezing may spare unnecessary treatments, such as would be used for asthma, or result in use of treatment more specific to tracheobronchomalacia such as bethanechol or aortopexy …”

Effect of Prenatal versus Postnatal Vitamin D Deficiency on Pulmonary Structure and Function in Mice

“…Thinner tracheal cartilage, therefore, may be a risk factor for tracheomalacia in the vitamin D-deficient mouse model. In humans, pliable tracheal cartilage is known to adversely affect flow dynamics during lower respiratory tract diseases (33,34).…”

ERS statement on protracted bacterial bronchitis in children

“…Overall, H. influenzae was the most common organism, found in 28-58% of children [4,31,32,37,42,56], with Streptococcus pneumoniae (13-58%) and Moraxella catarrhalis (17-59%) the two other most frequently detected organisms. These results are similar to findings in PBB (online supplementary table S3.2).…”