Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Investigation

Background:

• Bronchiectasis and asthma share overlapping clinical features, complicating diagnosis and treatment.
• The rationale for prophylactic inhaled corticosteroids (ICS) in pediatric bronchiectasis remains debated.
• Accurate diagnosis of co-existing asthma in children with bronchiectasis is challenging.

Purpose of the Study:

• To investigate the clinical characteristics associated with inhaled corticosteroids (ICS) prescription in children diagnosed with bronchiectasis.
• To understand the factors influencing the empirical use of ICS in pediatric non-cystic fibrosis bronchiectasis.

Main Methods:

• Retrospective review of data from 65 children (1.5-16 years) with radiologically confirmed non-CF bronchiectasis.
• Recorded variables included respiratory symptoms (dyspnea, wheezing), spirometry, IgE levels, eosinophil counts, allergen sensitization (skin prick tests - SPTs), and CT scan findings (air-trapping, mosaic pattern).
• Statistical analysis correlated clinical findings with ICS prescription.

Main Results:

• 33.8% experienced dyspnea and 35.4% experienced wheezing.
• 15 patients (23.0%) had positive SPTs, and 37 (56.9%) showed a mosaic pattern on CT scans.
• Dyspnea, mosaic pattern on CT, positive reversibility test, and positive SPTs were significantly associated with ICS prescription.

Conclusions:

• ICS prescription in pediatric bronchiectasis is more likely in patients exhibiting asthma-like features.
• Empirical ICS trials are often initiated due to diagnostic uncertainty between bronchiectasis and asthma.
• Clinical characteristics like dyspnea, air-trapping, and allergen sensitization guide ICS use in this population.