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Association of childhood tracheomalacia with bronchiectasis: a case-control study
Rahul Thomas1,2, Anne Chang3,2,4, Ian Brent Masters3,2
1Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia rahul.thomas@health.qld.gov.au.
Insights
Children with tracheomalacia, a tracheal deformity, have a significantly higher risk of developing bronchiectasis, a chronic lung condition. Early monitoring for persistent cough is recommended for these children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Imaging
Background:
- Tracheomalacia in children is linked to chronic lower airway infections and inflammation.
- A potential association between tracheomalacia and the development of bronchiectasis in pediatric populations has been suggested.
- This study aimed to investigate the relationship between tracheomalacia and bronchiectasis in children.
Purpose of the Study:
- To determine if tracheomalacia is associated with bronchiectasis in children.
- To quantify the risk of bronchiectasis in children with tracheomalacia compared to controls.
- To evaluate the diagnostic criteria for tracheomalacia in relation to bronchiectasis.
Main Methods:
- A single-center, case-control study was conducted.
- 45 children with confirmed bronchiectasis and 90 controls were included.
- Flexible bronchoscopy videos were reviewed blindly for tracheomalacia, with specific criteria including European Respiratory Society (ERS) definition.
Main Results:
- Children with bronchiectasis were younger than controls.
- Any degree of tracheomalacia was significantly associated with bronchiectasis (adjusted OR = 13.2).
- ERS-defined tracheomalacia showed a stronger association with bronchiectasis (adjusted OR = 24.4).
Conclusions:
- Bronchoscopic findings of tracheomalacia are associated with childhood bronchiectasis.
- While causality is not proven, the findings highlight the importance of monitoring children with tracheomalacia for bronchiectasis symptoms.
- Persistent or recurrent wet cough in children with tracheomalacia warrants investigation for bronchiectasis.
Objective:
Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis.
Design:
Single-centre, case-control study.
Setting And Patients:
45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT.
Interventions:
The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area).
Main Outcome Measures And Results:
Cases were younger (median age=2.6 years, IQR 1.5-4.1) than controls (7.8 years, IQR 3.4-12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity).
Conclusion:
Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.
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