Chest
Volume 133, Issue 2, February 2008, Pages 461-467
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Original Research
Tracheobronchomalacia
Quantified Tracheobronchomalacia Disorders and Their Clinical Profiles in Children

https://doi.org/10.1378/chest.07-2283Get rights and content

Background

Tracheobronchomalacia (TBM) disorders in children have never been studied using quantified measurements and validated clinical outcome measures. The objectives of the study were to prospectively examine the relationship between malacia lesions and their respiratory illness profiles.

Methods

The site of malacia lesions (eg, tracheomalacia, TBM, and bronchomalacia) were determined, measured, and related to the respective cricoid (ie, airway/cricoid ratio) using the color histogram mode technique. These children and normal control subjects were followed up for 12 months with their respiratory illness profiles determined using the Canadian Acute Respiratory Illness Scale (CARIFS) and cough diary scores.

Measurements

Outcome measures were respiratory illness frequency (> 12 months), severity score (day-1 CARIFS score), and significant cough interfering with daily activity (score of ≥ 3) and illness resolution (time to return to a quarter of CARIFS day 1 score).

Results

The group of 116 children were composed of patients with malacia (n = 81) and control subjects (n = 35). The median age of the group was 2.1 years (age range, 0.2 to 17.3 years). The adjusted relative risk of illness frequency was 2.1 (95% confidence interval [CI], 1.3 to 3.4), and of significant cough was 7.2 (95% CI, 1.01 to 27.22) for the malacia group while CARIFS day 1 score was 1.66 (95% CI, 1.1 to 2.56) compared to control subjects. Illness resolution rates at day 14 in the malacia group trended 25% slower than those for control subjects. Malacia type and severity of lesions were not associated with increased rates of illness or worse clinical profiles.

Conclusion

Children with malacia have an increased likelihood of respiratory illness frequency, severity, significant cough, and tendency for delayed recovery. However, neither the site nor the severity of malacia exhibited any significant dose effect on respiratory illness profiles.

Section snippets

Subjects

A group of 178 children with chronic respiratory symptoms of cough, stridor, or wheeze present for > 3 weeks underwent flexible bronchoscopy as a result of which malacia was diagnosed in 81 children; all were enrolled in the study over a 2-year period. A group of 31 healthy children were enrolled as control subjects. The Research and Ethics Committee of the Royal Children's Hospital approved the study, and consent for involvement in the project was obtained from each child's parent or caregiver.

Results

A total of 116 children (77 male) including 81 with malacia (57 male) were enrolled into the study. The median age of the entire study group was 2.1 years (minimum age, 0.2 years; maximum age, 17.3 years), while that of the malacia group (n = 81) was 1.9 years (minimum age, 0.2 years; maximum age, 12.4 years) and that of the control group (n = 35) was 3.8 years (minimum age, 0.2 years; maximum age, 17.3 years; p = 0.01). Although the control group was significantly older, these differences were

Discussion

This is the first reported prospective cohort study of children with malacia disorders that has quantified malacia lesions and used validated illness outcome measures of respiratory illness profiles. The risk of respiratory illnesses in the malacia group was twice that of the control group. When compared to control subjects, the severity of illness was 66% higher at the initial presentation of illness, while a significant cough score was four times more likely and a cough that disrupted or

Conclusions

Children with malacia have increased the rates of illness and the greater likelihood of more severe illness, and are more symptomatic with a tendency to delayed recovery from illness within the first year after diagnosis. However, neither the sites nor the severity of malacia exhibited a dose effect on rates or severity of illness.

ACKNOWLEDGMENT

The authors would like to acknowledge the support of the parents, children, and staff of the Royal Children's Hospital who participated in this study. In particular, we thank Mr. Justin Gaffney and Carol Willis for their nursing and organizational support. We thank Dr. Jan Wuth for her anesthetic expertise during bronchoscopic procedures, and Dr. Paul Francis for the departmental support of the project.

References (18)

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Support for Dr. Chang was given by the National Health and Medical Research Council.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products of services may be discussed in this article.

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