Chest
Original ResearchTracheobronchomalaciaQuantified Tracheobronchomalacia Disorders and Their Clinical Profiles in Children
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)
- et al.
Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review
Chest
(2005) - et al.
Canadian Acute Respiratory Illness and Flu Scale (CARIFS): development of a valid measure for childhood respiratory infections
J Clin Epidemiol
(2000) - et al.
A children's acute respiratory illness scale (CARIFS) predicted functional severity and family burden
J Clin Epidemiol
(2004) - et al.
Evaluation and outcome of young children with chronic cough
Chest
(2006) - et al.
Tracheomalacia
Ann Otol Rhinol Laryngol
(1963) - et al.
Pediatric tracheobronchomalacia and major airway collapse
Ann Otol Rhinol Laryngol
(1992) - et al.
Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method
Eur Respir J
(1998) - et al.
Treatment of adult tracheobronchomalacia and excessive dynamic airway collapse: an update
Treat Respir Med
(2006) - et al.
Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope
Respir Res
(2005)
Cited by (61)
Yardstick for managing cough, part 2: In children
2023, Annals of Allergy, Asthma and ImmunologyStructural Abnormalities at Birth (Haemangioma, TOF, Airway Malacia, CPM)
2021, Encyclopedia of Respiratory Medicine, Second EditionManaging Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report
2020, ChestCitation Excerpt :Airway malacia impedes clearance of secretions166 and it is plausible that the prolonged cough in these children relates to a bronchitic process distal to the lesion. Indeed, a prospective study167 on children with malacia found increased likelihood of respiratory illness frequency, severity, significant cough and a tendency for delayed recovery but neither the site nor severity of malacia had a dose effect on respiratory illness. Although persistent cough is listed as an indication for FB,84,168 its role in those with isolated chronic cough has yet to be defined prospectively.
Ultrashort Echo-Time MRI for the Assessment of Tracheomalacia in Neonates
2020, ChestCitation Excerpt :Furthermore, the lack of a standardized definition also allows for interrater variability when interpreting TM based on bronchoscopy, although we achieved very good interrater agreement with agreed upon definitions and extensive training cases. Quantitative methods have been described to determine collapse of the trachea based on bronchoscopy; however, this is not routinely implemented in clinical practice.26,28,31 Perhaps the most challenging aspect of using bronchoscopy for assessing TM is that the use of an invasive procedure prevents evaluation of the trachea in healthy children, severely limiting the understanding of normal airway dynamics.
Bronchiectasis and Chronic Suppurative Lung Disease
2019, Kendig's Disorders of the Respiratory Tract in Children
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.