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Primary bronchomalacia in infants and children
1Division of Pediatric Pulmonology, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Insights
Primary bronchomalacia in infants often presents as reactive airways disease. While symptoms improve with age, severe cases may lead to exercise limitations later in life.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Diagnostics
Background:
- Primary bronchomalacia is a congenital condition affecting the airways.
- It is often misdiagnosed as reactive airways disease in infants.
- Early identification is crucial for appropriate management.
Purpose of the Study:
- To investigate the natural history of primary bronchomalacia in pediatric patients.
- To understand the typical presentation and diagnostic challenges.
- To assess long-term outcomes and potential complications.
Main Methods:
- Retrospective chart review of 17 patients with confirmed primary bronchomalacia.
- Follow-up telephone questionnaires were used to gather outcome data.
- Bronchoscopic confirmation of the diagnosis was a key inclusion criterion.
Main Results:
- All patients presented with symptoms in the first six months of life.
- A harsh, monophonic wheeze loudest over the central airway was a common symptom.
- While daily symptoms resolved with growth, 3 patients over 5 years old reported exercise limitations.
Conclusions:
- Bronchomalacia should be considered in the differential diagnosis of persistent infant wheezing.
- Appropriate evaluation is necessary for accurate diagnosis.
- Severe bronchomalacia may lead to long-term exercise limitations, indicating incomplete resolution.
Objective:
To determine the natural history of primary bronchomalacia in infants and children.
Study Design:
Retrospective chart review and follow-up telephone questionnaire of 17 patients with bronchoscopically confirmed primary bronchomalacia.
Results:
All patients had initial symptoms within the first 6 months of life, and all patients were thought by their primary care physicians to have reactive airways disease. In no patient was the diagnosis of bronchomalacia considered before referral to our center. All patients had a harsh, monophonic wheeze loudest over the central airway and intermittently present between illnesses. All 17 patients had bronchomalacia of the left main-stem bronchus; two had mild tracheomalacia associated with the bronchomalacia; and one had bilateral bronchomalacia. One patient had associated laryngomalacia. Twenty-five percent of our patients had reactive airway disease in addition to bronchomalacia. With growth, all patients have shown a gradual improvement and a cessation of daily symptoms. All three patients older than the age of 5 years report limitation of vigorous exercise.
Conclusions:
Bronchomalacia should be considered in the differential diagnosis of the persistently wheezing infant and should be evaluated appropriately. More severe forms of bronchomalacia appear to predispose patients to exercise limitation later in life, which suggests that the lesion does not completely resolve with growth.