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Longitudinal quantification of growth and changes in primary tracheobronchomalacia sites in children
Ian B Masters1, Paul V Zimmerman, Anne B Chang
1School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston, Brisbane, Australia. brent_masters@health.qld.gov.au
Insights
Longitudinal data on tracheobronchomalacia in children is scarce. This study found malacia lesions grow similarly to normal airway sites, but new lesions can develop, unaffected by type or severity.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Imaging
Background:
- Longitudinal data on tracheobronchomalacia (TBM) in children is lacking.
- Understanding TBM progression is crucial for improving patient outcomes.
Purpose of the Study:
- To longitudinally characterize TBM lesions using bronchoscopy.
- To quantify lumen cross-sectional area (CSA) changes in TBM.
- To correlate TBM measurements with clinical illness profiles.
Main Methods:
- Utilized a validated color histogram mode technique for quantifying TBM lesions and airway CSA.
- Prospectively collected data on illness frequency, validated illness scales, and cough diaries.
- Assessed clinical profiles alongside bronchoscopic measurements.
Main Results:
- Analyzed 35 TBM sites in 21 children; 60% of lesions increased in CSA.
- Observed a median yearly growth rate of 3.65 mm²/year for TBM sites and 5.38 mm²/year for non-TBM sites (P=0.31).
- No significant association found between lesion type/severity and growth rates or clinical scores.
Conclusions:
- TBM lesions exhibit similar growth rates to normal airway sites.
- Worsening of existing TBM and development of new lesions can occur.
- Neither TBM type nor severity impacts lesion growth patterns or clinical presentation.
Rationale:
Longitudinal follow-up of children with tracheobronchomalacia is essential to improving our understanding of these disorders, yet currently, there is no such data.
Objectives:
To longitudinally define malacia sites and quantify the cross-sectional area (CSA) of the lumen using a bronchoscopic technique and to relate these measurements to illness profiles.
Methods:
The validated color histogram mode technique was utilized to quantify primary malacia lesions and airway sites' CSA. Illness frequency, validated scales of illness and cough diary scores were prospectively used to assess clinical profiles.
Results:
Thirty-five malacia sites were defined from the 2 studies of 21 children. CSA of 21 (60%) of the malacia lesions increased, 5 (14%) new lesions appeared, 5 (14%) decreased in size, 3 (8%) remained unchanged, and 1(3%) was indeterminate. Overall there was no statistically significant change in paired-data assessments of malacia sites' area while there was a significant increase in area of non-malacia sites. The median yearly growth rate for the malacia sites and non-malacia was 3.65 mm2/year sites and 5.38 mm2/year, respectively (P = 0.31). The type and severity of lesion was not associated with any difference in growth rates, illness frequency or clinical scores.
Conclusions:
Malacia lesions increase in size at the same rate as non-malacia sites. However malacia may worsen and new primary lesions may develop. Neither malacia type nor severity influences their growth pattern or illness profile.
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