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Tracheomalacia and bronchomalacia in children: incidence and patient characteristics

Ruben Boogaard1, Sjoerd H Huijsmans, Marielle W H Pijnenburg

  • 1Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Centre, Department of Pediatrics, Division of Pediatric Pulmonology, Rotterdam, the Netherlands. r.boogaard@erasmusmc.nl

Chest
|November 24, 2005
PubMed

Insights

Congenital airway malacia, a cause of irreversible airway obstruction in children, occurs in at least 1 in 2,100. Clinical diagnosis is challenging due to overlapping symptoms with asthma, necessitating bronchoscopy for definitive diagnosis.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Pediatric Airway Disorders

Background:

  • Congenital airway malacia causes irreversible airway obstruction in children.
  • The incidence and clinical features of primary airway malacia are not well-established.
  • Early diagnosis is crucial, especially for cases not associated with syndromes.

Purpose of the Study:

  • To determine the incidence of primary airway malacia in children.
  • To describe the clinical features of children with primary airway malacia.
  • To evaluate the accuracy of clinical diagnosis before flexible bronchoscopy.

Main Methods:

  • Analysis of flexible bronchoscopies performed between 1997 and 2004.
  • Summarization of clinical features in children diagnosed with primary airway malacia.
  • Estimation of primary airway malacia incidence and predictive value of clinical diagnosis.

Main Results:

  • Airway malacia was diagnosed in 160 of 512 children, with 136 classified as primary.
  • The incidence of primary airway malacia was estimated at a minimum of 1 in 2,100 children.
  • Clinical diagnosis was correct in 74% of suspected cases, but often not suspected prior to bronchoscopy (52%).
  • Clinical features were variable and overlapped with allergic asthma; peak expiratory flow was more reduced than FEV1.

Conclusions:

  • Primary airway malacia is relatively common, with an incidence of at least 1 in 2,100.
  • Clinical recognition is difficult due to overlapping symptoms with common respiratory conditions.
  • Bronchoscopy is recommended for children with unexplained exercise intolerance, recurrent infections, or atypical asthma to rule out airway malacia.
Abstract

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