Bronchoscopy Findings in Children with Asthma

SymptomsÖzge Pamukçu,

Z.S. Uyan, E. Çakır, S. Öktem, F. Karakoç, B. Karadağ, R. Ersu, E. Dağlı

Marmara University Medical Faculty, Dep. of Pediatric

Pulmonology,İSTANBUL

IntroductionPersistent or recurrent wheezing in infancy is a common

symptom.

Prevalance of wheezing in infancy varies from 4 to 32%

In wheezy children flexible bronchoscopy is indicated to

evaluate associated anatomic and/or functional

abnormalities.

Flexible bronchoscopy is an important diagnostic tool in the

differential diagnosis of wheezing and treatment plan of

asthma.

Introduction

Patients who respond poorly to corticosteroids, particularly

those in whom unconventional therapies are being

considered, should undergo bronchoscopy.

This allows direct inspection of the airways and gives an

opportunity for examination of the underlying pathology.

29 of the 34 patients with persistent and/or recurrentwheezing whose symptoms recurred or did not improvedespite bronchodilator and steroid treatment hadfunctional and/or structural respiratory tract anomalies. Aslan Allergy and Asthma Nov 2005

A retrospective case series was reported in whichbronchoscopy was used to investigate 30 young childrenwith recurrent wheezing who had been poorly responsive tobronchodilators. Although they had been tentatively labeledas asthmatic patients, tracheomalacia was found in almostone-half of the cases. Schellhase J. Pediatrics 1998

In a recent study of 885 bronchoscopic procedures, 299

cases of malacia disorders (34%) were observed.

Masters Pediatric Pulmonology 2002

In another study of 17 patients with onset of wheezing

earlier than 6 months of age and a diagnosis of

hyperreactive airway disease, bronchomalacia was

detected in flexible bronchoscopy. Finder J. Pediatrics 1997

No complications had been observed after bronchoscopy of

36 asthmatic subjects. Humbert, Thorax BMJ

1996

Flexible bronchoscopy was performed to 48 children with

Difficult asthma and 35 nonasthmatic children. The total

number of perioperative complications was greater in the

non-asthmatics undergoing flexible bronchoscopy than in

the asthmatics. Payne, Arch Dis Child 2001

Aim

To investigate the efficacy and the safety of bronchoscopy

in children with persistent or recurrent wheezing.

Method

We retrospectively reviewed the bronchoscopy results of

112 patients that have been followed for persistent or

recurrent wheezing in our clinic.

Results

Demographic characteristics of patients

Sex Age

(median)

Duration of symptoms

(median)

Male: 62 % 13.5 months

(IQR: 7- 44)

5 months

(IQR: 2- 14)

Results

The diagnosis of 40 % of the patients was changed after

bronchoscopy; bronchoscopy results of 30 % of patients

were normal

Laryngotracheomalacia

Foreign BodyAspiration

External Compression

Anatomic Variation

Secretion

Normal

Bronchoscopy Results

Results

33.5% 26,5%

12.4%2.7% 11.5%

12.4%

Results

Rates of complications7,4%

92,6%

No complications

Minor complications

Results

Hypoxia

Transient tachycardia

Stridor

No complication

92,6%

0,9%

0,9%5,6%

None of the patients had major complications

Conclusion

Flexible bronchoscopy has an important role in the

differential diagnosis of young patients who have asthma

symptoms and it is a safe procedure without any major

complications.

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