Related Experiment Video
Updated: May 23, 2026
Systematic Bronchoscopy: the Four Landmarks Approach
Published on: June 23, 2023
Bronchoscopy contributes to the clinical management of indigenous children newly diagnosed with bronchiectasis
Susan J Pizzutto1, Keith Grimwood, Paul Bauert
1Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. susan.pizzutto@menzies.edu.au
Insights
Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) significantly impacts initial treatment for children with non-cystic fibrosis bronchiectasis. These procedures are valuable for identifying eosinophilia, infections, and foreign bodies, guiding management in pediatric cases.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Investigation
Background:
- Flexible bronchoscopy (FB) is sometimes routinely used for suspected pediatric bronchiectasis.
- Limited published data exist on the efficacy of routine FB in this population.
Purpose of the Study:
- To assess the clinical utility of FB and bronchoalveolar lavage (BAL) in the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.
- To determine if FB and BAL findings alter empiric treatment strategies.
Main Methods:
- Prospective data collection from 56 children (0.8-9.8 years) undergoing FB and BAL for suspected bronchiectasis.
- Management alteration defined by identification of airway obstruction, lower airway eosinophilia (>2.5% BAL eosinophils), or significant bacterial growth (>10^4 CFU/ml) requiring antibiotic change.
Main Results:
- FB and BAL altered empiric treatment in 23 of 56 children (41%).
- Lower airway eosinophilia was found in 34% of children.
- BAL microbiology led to antibiotic changes in 9%, and a foreign body was found in 2%.
Conclusions:
- Flexible bronchoscopy with bronchoalveolar lavage is a valuable tool in the initial investigation of non-CF bronchiectasis in children.
- Findings support the inclusion of FB with BAL in the initial workup, particularly for Indigenous children, contrary to some localized recommendations.
Background:
Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.
Objective:
To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.
Method:
We examined FB and BAL data collected prospectively in 56 children aged 0.8-9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >10(4) colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.
Results:
Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%).
Conclusion:
Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.
Related Concept Videos
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due to...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:23The Bronchial Tree
The trachea, commonly known as the windpipe, is a tube that connects the larynx (voice box) to the bronchi. At a point called the carina, it bifurcates into two primary bronchi. The right primary bronchus is wider, shorter, and more vertical than the left primary...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:24Chronic Obstructive Pulmonary Disease III: Chronic Bronchitis Features
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...