Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children—Experiences from National Pediatric Center
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Flexible Bronchoscopy and Bronchoalveolar Lavage
2.2.1. Interpretation of Bronchoscopy Findings
2.2.2. Interventions
2.3. Statistical Analysis
3. Results
3.1. Bronchoscopy Findings
3.2. Upper Gastrointestinal Series and BALF Findings
3.3. Hospitalization Length
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Martinez, F.D.; Wright, A.L.; Taussig, L.M.; Holberg, C.J.; Halonen, M.; Morgan, W.J. Asthma and Wheezing in the First Six Years of Life. The Group of Health Associates. N. Engl. J. Med. 1995, 332, 133–138. [Google Scholar] [CrossRef] [Green Version]
- Ren, C.L.; Esther, C.R., Jr.; Debley, J.S.; Sockrider, M.; Yilmaz, O.; Amin, N.; Bazzy-Asaad, A.; Davis, S.D.; Durand, M.; Ewig, J.M.; et al. Official American thoracic society clinical practice guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing. Am. J. Respir. Crit. Care Med. 2016, 194, 356–373. [Google Scholar] [CrossRef]
- Priftis, K.N.; Anthracopulos, M.B.; Eber, E.; Koumburlis, A.C.; Wood, R.E. (Eds.) Paediatric Bronchoscopy. Progress in Respiratory Research; Karger: Basel, Switzerland, 2010. [Google Scholar]
- De Blic, J.; Midulla, F.; Barbato, A.; Clement, A.; Dab, I.; Eber, E.; Green, C.; Grigg, J.; Kotecha, S.; Kurland, G.; et al. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur. Respir. J. 2000, 15, 217–231. [Google Scholar] [PubMed]
- Le Bourgeois, M.; Goncalves, M.; La Clainche, L.; Benoist, M.R.; Fournet, J.C.; Scheinmann, P.; de Blic, J. Bronchoalveolar cells in children <3 years old with severe recurrent wheezing. Chest 2002, 122, 791–797. [Google Scholar] [CrossRef] [PubMed]
- Furuya, M.E.; Moreno-Córdova, V.; Ramírez-Figueroa, J.L.; Vargas, M.H.; Ramón-García, G.; Ramírez-San Juan, D.H. Cutoff value of lipid-laden alveolar macrophages for diagnosing aspiration in infants and children. Pediatr. Pulmonol. 2007, 42, 452–457. [Google Scholar] [CrossRef] [PubMed]
- Wallis, C.; Alexopoulou, E.; Antón-Pacheco, J.L.; Bhatt, J.M.; Bush, A.; Chang, A.B.; Charatsi, A.M.; Coleman, C.; Depiazzi, J.; Douros, K.; et al. ERS Statement on Tracheomalacia and Bronchomalacia in Children. Eur. Respir. J. 2019, 54, 1900382. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Boesch, R.P.; Baughn, J.M.; Cofer, S.A.; Balakrishnan, K. Trans-nasal flexible bronchoscopy in wheezing children: Diagnostic yield, impact on therapy, and prevalence of laryngeal cleft. Pediatr. Pulmonol. 2018, 53, 310–315. [Google Scholar] [CrossRef] [PubMed]
- Saito, J.; Harris, W.T.; Gelfond, J.; Noah, T.L.; Liegh, M.W.; Johnson, R.; Davis, S.D. Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough. Pediatr. Pulmonol. 2006, 41, 709–719. [Google Scholar] [CrossRef]
- Wang, C.F.; Tang, L.F.; Chen, Z.M.; Zhang, Y.Y.; Wang, Y.S.; Xu, Y.C. Application of flexible bronchoscopy in the aetiological diagnosis of childhood refractory wheezing. Hong Kong J. Paediatr. 2011, 16, 164–168. [Google Scholar]
- Cakir, E.; Ersu, R.H.; Uyan, Z.S.; Oktem, S.; Karadag, B.; Yapar, O.; Pamukcu, O.; Karakoc, F.; Dagli, E. Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children. Int. J. Pediatr. Otorhinolaryngol. 2009, 73, 1666–1668. [Google Scholar] [CrossRef] [PubMed]
- De Baets, F.; De Schutter, I.; Aarts, C.; Haerynck, F.; Van Daele, S.; De Wachter, E.; Malfroot, A.; Schelstraete, P. Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms. Eur. Respir. J. 2012, 39, 392–395. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- De Schutter, I.; Dreesman, A.; Soetens, O.; De Waele, M.; Crokaert, F.; Verhaegen, J.; Piérard, D.; Malfroot, A. In young children, persistent wheezing is associated with bronchial bacterial infection: A retrospective analysis. BMC Pediatr. 2012, 12, 83. [Google Scholar] [CrossRef] [Green Version]
- Schellhase, D.E.; Fawcett, D.D.; Schutze, G.E.; Lensing, S.Y.; Tryka, A.F. Clinical utility of flexible bronchoscopy and bronchoalveolar lavage in young children with recurrent wheezing. J. Pediatr. 1998, 132, 312–318. [Google Scholar] [CrossRef]
- Saglani, S.; Nicholson, A.G.; Scallan, M.; Balfour-Lynn, I.; Rosenthal, M.; Payne, D.N.; Bush, A. Investigation of young children with severe recurrent wheeze: Any clinical benefit? Eur. Respir. J. 2006, 27, 29–35. [Google Scholar] [CrossRef] [Green Version]
- Eber, E.; Antón-Pacheco, J.L.; de Blic, J.; Doull, I.; Faro, A.; Nenna, R.; Nicolai, T.; Pohunek, P.; Priftis, K.N.; Serio, P.; et al. ERS statement: Interventional bronchoscopy in children. Eur. Respir. J. 2017, 50, 1700901. [Google Scholar] [CrossRef] [Green Version]
- Marchant, J.M.; Masters, I.B.; Taylor, S.M.; Cox, N.C.; Seymour, G.J.; Chang, A.B. Evaluation and outcome of young children with chronic cough. Chest 2006, 129, 1132–1141. [Google Scholar] [CrossRef] [Green Version]
- Marchant, J.M.; Masters, I.B.; Taylor, S.M.; Chang, A.B. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax 2006, 61, 694–698. [Google Scholar] [CrossRef] [Green Version]
- Donnelly, D.; Critchlow, A.; Everard, M.L. Outcomes in children treated for persistent bacterial bronchitis. Thorax 2007, 62, 80–84. [Google Scholar] [CrossRef] [Green Version]
- Krawiec, M.E.; Westcott, J.Y.; Chu, H.W.; Balzar, S.; Trudeau, J.B.; Schwartz, L.B.; Wenzel, S.E. Persistent wheezing in very young children is associated with lower respiratory inflammation. Am. J. Respir. Crit. Care Med. 2001, 163, 1338–1343. [Google Scholar] [CrossRef] [PubMed]
- Buts, J.P.; Barudi, C.; Moulin, D.; Claus, D.; Cornu, G.; Otte, J.B. Prevalence and treatment of silent gastro-oesophageal reflux in children with recurrent respiratory disorders. Eur. J. Pediatr. 1986, 145, 396–400. [Google Scholar] [CrossRef]
- Balson, B.M.; Kravitz, E.K.; McGeady, S.J. Diagnosis and treatment of gastroesophageal reflux in children and adolescents with severe asthma. Ann. Allergy Asthma. Immunol. 1998, 81, 159–164. [Google Scholar] [CrossRef]
- Rosen, R.; Fritz, J.; Nurko, A.; Simon, D.; Nurko, S. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics 2008, 121, e879–e884. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sacco, O.; Fregonese, B.; Silvestri, M.; Sabatini, F.; Mattioli, G.; Rossi, G.A. Bronchoalveolar lavage and esophageal pH monitoring data in children with “difficult to treat” respiratory symptoms. Pediatr. Pulmonol. 2000, 30, 313–319. [Google Scholar] [CrossRef]
Sex, n (%) | |
---|---|
Male | 98 (57) |
Female | 74 (43) |
Age in months, mean ± SD | 30.9 ± 44.6 |
Hospitalization length in days, median (range) | 6 (1–15) |
Gestational age, n (%) | |
<36 g.w. | 22 (12.8) |
>36 g.w. | 140 (81.4) |
Birth weight, n (%) | |
<2500 g | 51 (29.7) |
>2500 g | 107 (62.2) |
Perinatal events, n (%) | |
Esophageal atresia with TOF | 1 (0.6) |
Sepsis | 6 (3.5) |
Mechanical ventilation | 11 (6.4) |
Apgar score, median (range) | 9 (2–10) |
Breastfeeding, n (%) | 78 (45.3) |
Eczema, n (%) | 22 (12.8) |
Atopy in family, n (%) | 51 (29.7) |
Therapy, n (%) | |
Systemic corticosteroids | 132 (76.7) |
Inhaled bronchodilators | 109 (63.4) |
Oxygen therapy | 52 (30.2) |
3% NaCl | 27 (15.7) |
Antibiotics | 106 (61.6) |
Inhaled corticosteroids | 146 (84.9) |
Bronchoscopy Finding, n (%) | |
---|---|
Normal | 21 (12.2) |
BLAI | 83 (48.3) |
Bronchomalacia | 35 (20.4) |
Tracheomalacia | 5 (2.9) |
Mucus plugging | 48 (27.9) |
Bronchial stenosis | 7 (4.1) |
Extramural compression | 11 (6.4) |
Microbiology isolates, n (%) | |
Normal flora | 40 (23.3) |
Haemophilus influenzae | 38 (22.1) |
Streptococcus pneumoniae | 36 (20.9) |
Staphylococcus aureus | 17 (9.9) |
Moraxella catarrhalis | 25 (14.5) |
Other | 36 (20.9) |
Upper gastrointestinal series finding, n (%) | |
Normal | 149 (86.6) |
Pathological | 23 (13.4) |
Swallowing study finding, n (%) | |
Normal | 154 (89.5) |
Pathological | 18 (10.5) |
Boesch et al. [8] | Saito et al. [9] | Wang et al. [10] | Cakir et al. [11] | De Baets et al. [12] | |
---|---|---|---|---|---|
Number of participants | 94 | 19 | 246 | 113 | 124 |
Sex, male % | 62 % | 63 % | 59 % | 63 % | 53 % |
Age, mean (range) | 3.3 y (3 m–18 y) | 12.5 m (5 m–26 m) | 17 m (1 m–9 y) | 14 m (7 m–44 m) | 10 m (7 m–14 m) |
Normal bronchoscopy finding, n (%) | 12 (11.9) | 0 (0) | ▪ | 59 (52) | 24 (19.4) |
Bronchitis, n (%) | 50 (49.5) | 8 (42) | ▪ | ▪ | 79 (63.7) |
Bronchomalacia, n (%) | 10 (9.9) | ▪ | ▪ | 7 (6.2) | 11 (9) |
Tracheomalacia, n (%) | 18 (17.8) | ▪ | ▪ | 18 (15.9) | 24 (19.4) |
Mucus plugging, n (%) | ▪ | ▪ | 52 (21.1) | ▪ | ▪ |
Foreign body, n (%) | 1 (1) | 1 (5) | 22 (8.9) | 14 (12) | ▪ |
Bronchial stenosis, n (%) | 1 (1) | ▪ | 15 (6.1) | ▪ | ▪ |
Extramural compression, n (%) | 15 (14.8) | ▪ | ▪ | 2 (2) | 4 (3) |
Wang et al. [10] | Saito et al. [9] | Le Bourgeois et al. [5] | De Schutter et al. [13] | Schellhase et al. [14] | De Baets et al. [12] | Saglani et al. [15] | |
---|---|---|---|---|---|---|---|
Number of participants | 246 | 19 | 83 | 33 | 30 | 124 | 47 |
Sex, males % | 59% | 63% | 70% | 64% | ▪ | 53% | 53% |
Age, mean (range) | 17 m (1 m–9 y) | 12.5 m (5–26 m) | 11.3 m (4–32 m) | 10 m (4–38 m) | 0–18 m | 10 m (7–14 m) | 26 m (5–58 m) |
BAL performed, n | 98 | 19 | 83 | 33 | 27 | 124 | 44 |
BAL culture done, n | 98 | 18 | 30 | 33 | 27 | 124 | 44 |
Positive BAL culture, n (%) | 17 (17.3) | 11 (61) | 18 (60) | 16 (48.5) | 3 (11.1) | 69 (56) | 12 (27) |
H. influenzae, n (%) | 0 (0) | 5 (27.8) | 9 (30) | 10 (30.3) | 1 (3.7) | 35 (28) | 8 (18) |
S. pneumoniae, n (%) | 0 (0) | 4 (22.2) | 4 (13.3) | 4 (12.1) | 0 (0) | 16 (13) | 1 (2) |
M. catarrhalis, n (%) | 0 (0) | 8 (44.4) | 3 (10) | 4 (12.1) | 2 (7.4) | 63 (51) | 5 (11) |
S. aureus, n (%) | 0 (0) | ▪ | 3 (10) | 1 (3) | 0 (0) | 12 (10) | 1 (2) |
↑ LLMI, n (%) | ▪ | ▪ | ▪ | ▪ | 5 (18.5) | ▪ | 10 (24) |
Neutrophilic inflammation, n (%) | ▪ | 9(47) | ▪ | 24/28 (85.7) | ▪ | ▪ | 16/37 (43) |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sovtic, A.; Grba, T.; Grahovac, D.; Minic, P. Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children—Experiences from National Pediatric Center. Medicina 2020, 56, 329. https://doi.org/10.3390/medicina56070329
Sovtic A, Grba T, Grahovac D, Minic P. Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children—Experiences from National Pediatric Center. Medicina. 2020; 56(7):329. https://doi.org/10.3390/medicina56070329
Chicago/Turabian StyleSovtic, Aleksandar, Tijana Grba, Danilo Grahovac, and Predrag Minic. 2020. "Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children—Experiences from National Pediatric Center" Medicina 56, no. 7: 329. https://doi.org/10.3390/medicina56070329