Flexible Bronchoscopy in Young Children with Treatment-Refractory Wheeze

Flexible Bronchoscopy in Refractory Wheeze

Abstract

Aim: To evaluate the clinical utility of flexible bronchoscopy (FB) in young children with persistent or treatment-refractory wheeze.

Materials and Methods: This retrospective audit was conducted at the pediatric bronchoscopy service of a tertiary care center and included children aged ≤5 years who underwent flexible bronchoscopy (FB) for persistent or poorly responsive wheeze between January 2020 and December 2024. Clinical, demographic, bronchoscopic, and procedural data were retrieved from medical records. Structural and dynamic airway abnormalities were recorded. Tracheomalacia and bronchomalacia were defined as >50% reduction in airway lumen during expiration.

Results: Of 623 bronchoscopies performed during the study period, 65 were undertaken for treatment-refractory wheeze. After exclusion of 23 children because of inadequate data, 42 were analyzed. Mean age was 27.6±12.6 months and mean symptom duration was 10.1±6.5 months. Generalized wheeze was present in 33 (78.6%) children and localized wheeze in 7 (16.7%); 2 had inspiratory stridor with expiratory wheeze. Dynamic airway abnormalities were identified in 16 (38.1%). Tracheomalacia was found in 7 (16.7%), three children in this subgroup had double aortic arch. Bronchomalacia was present in 3 (7.1%), all with congenital heart disease. Laryngeal abnormalities were associated with tracheomalacia in 4 children. No major procedural complications occurred. Minor events included transient hypoxia in 8 (19.0%) and epistaxis in 4 (9.5%).

Conclusions: FB identified structural or dynamic airway abnormalities in a substantial proportion of young children with treatment-refractory wheeze. It may be useful in selected children, particularly when symptoms persist despite conventional therapy or an airway or vascular abnormality is suspected.