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Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children
Erkan Cakir1, Refika Hamutcu Ersu, Zeynep Seda Uyan
1Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey. erkancakir1@yahoo.com
Insights
Flexible bronchoscopy (FOB) offers a safe and effective method for diagnosing persistent wheezing in children unresponsive to standard treatments. Early FOB evaluation aids in accurate diagnosis, reducing costs and unnecessary interventions.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Procedures
- Respiratory Medicine
Background:
- Persistent wheezing in children presents a diagnostic challenge, often leading to extensive investigations and treatments.
- Standard therapies like bronchodilators and inhaled steroids may not resolve persistent wheezing.
- Identifying the underlying cause is crucial for effective management and cost reduction.
Purpose of the Study:
- To assess the efficacy and safety of flexible bronchoscopy (FOB) in pediatric patients with persistent wheezing.
- To evaluate FOB as a diagnostic tool for children who have not responded to conventional therapies.
- To determine the rate of pathological findings and complications associated with FOB in this population.
Main Methods:
- A retrospective study included 113 children with persistent wheezing (≥6 weeks) unresponsive to bronchodilator and inhaled steroid therapy.
- Flexible bronchoscopy was performed on all eligible patients between 1997 and 2009.
- Data collected included patient demographics, symptom duration, bronchoscopic findings, and procedural complications.
Main Results:
- Pathological findings were identified in 48% of patients, including malacia disorders (38%), foreign body aspiration (14%), and vascular rings (2%).
- Flexible bronchoscopy was well-tolerated, with major or minor complications occurring in only 8% of patients (transient hypoxia, stridor, tachycardia).
- The procedure provided rapid and definitive diagnoses for the majority of children evaluated.
Conclusions:
- Flexible bronchoscopy is a safe and effective procedure for diagnosing persistent wheezing in children.
- Early consideration of FOB can lead to accurate diagnoses, preventing unnecessary treatments and reducing healthcare costs.
- FOB should be considered a valuable tool in the evaluation of pediatric persistent wheezing.
Background:
Persistent wheezing is a common problem in early childhood and leads to a diagnostic dilemma, excessive investigations, drug administration and additional cost.
Objective:
To determine the efficacy and the safety of FOB in children with persistent wheezing despite bronchodilator and inhaled steroid therapy.
Methods:
Patients with persistent wheezing that lasted at least 6 weeks and did not respond to bronchodilator and inhaled steroid therapy and to whom flexible bronchoscopy was performed were included to the study.
Results:
Between 1997 and 2009; 113 patients were enrolled to the study. Sixty-three percent of the children were male. Median age was 14 months at presentation and median duration of symptoms was 5 months. Bronchoscopy revealed pathological findings in 48% of the patients. Thirty-eight patients had malacia disorders, 14 had foreign body aspiration and two had external compression of airways which were later diagnosed as vascular ring. Major and minor complications were not seen in 92% of the patients while transient hypoxia was seen in 6%, stridor in 1% and tachycardia in 1% of the patients.
Conclusion:
Flexible bronchoscopy provided rapid and definitive diagnosis for our patients with persistent wheezing without any major complications. This study is one of the largest studies concerning persistent wheezing. Early bronchoscopic evaluation can reduce cost by providing rapid and accurate diagnosis and preventing unnecessary investigations and drug administration. Flexible bronchoscopy is a safe procedure and should be considered in the evaluation of children with persistent wheezing.
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