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Bronchoscopic interventions for plastic bronchitis in children without structural heart disease.
Erin F Kallam1, Ajay S Kasi1, Rucha Patki1
1Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
European Journal of Pediatrics
|June 23, 2021
Summary
Plastic bronchitis (PB) in children without heart disease is often linked to asthma, which increases recurrence risk. Bronchoscopic cryotherapy offers a safe and effective treatment for airway cast obstruction.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Plastic bronchitis (PB) is a rare, life-threatening condition causing airway obstruction via branching casts.
- PB is most frequently observed in children with congenital heart disease, often leading to high recurrence and mortality rates.
Purpose of the Study:
- To describe the clinical features, management, and outcomes of PB in children without structural heart disease.
- To identify risk factors for recurrence and evaluate treatment efficacy in this specific pediatric population.
Main Methods:
- Retrospective cohort study of 12 pediatric patients with non-structural heart disease-related PB.
- Analysis of clinical data, including diagnoses, ventilatory support, bronchoscopic interventions (cryotherapy), chest physiotherapy, and medications.
Main Results:
- Asthma was the most common diagnosis (67%).
- Bronchoscopy was required in 92% of patients; cryotherapy was effective in two refractory cases.
- One patient died despite extracorporeal membrane oxygenation (ECMO); one-third experienced recurrent PB, all with asthma.
Conclusions:
- Asthma is identified as a significant risk factor for recurrent plastic bronchitis in children without structural heart disease.
- Bronchoscopic interventions, particularly cryotherapy, are demonstrated as safe and effective for managing refractory PB.
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