Association of childhood tracheomalacia with bronchiectasis: a case–control study

Abstract

ObjectiveChildren 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.DesignSingle-centre, case–control study.Setting and patients45 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.InterventionsThe 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 resultsCases 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).ConclusionBronchoscopic-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.

History Taking as a Diagnostic Tool in Children With Chronic Cough

“…These airway anomalies seem to be predisposed to and are closely associated with chronic recurrent airway infection and consequent inflammation. For example, a recent case-control study demonstrated that the presence of tracheomalacia (defined by European Respiratory Society as >50% expiratory reduction in the cross-sectional luminal area seen on flexible bronchoscopy) is an independent risk factor for bronchiectasis with an adjusted odds ratio of 24.4, and a 95% confidence interval (CI) of 3.4 to infinity (18).…”

Gastrointestinal factors associated with risk of bronchiectasis in children

“…Apart from bronchiectasis related to cystic fibrosis and recurrent pneumonia, there is little understanding about its etiology in pediatrics but prevalence appears to be increasing and more than 20% have no clear cause identified 3,6,7 . Diagnostic work‐up and management for these patients varies widely and it is likely these factors impact clinical outcomes as some studies have suggested reversal of disease with treatment 1,8,9 . However, little is known about risk factors for disease and better understanding of these risks might allow for targeted approaches to prevent ongoing pulmonary damage in pediatric patients who are at risk 10,11 …”

“…3,6,7 Diagnostic workup and management for these patients varies widely and it is likely these factors impact clinical outcomes as some studies have suggested reversal of disease with treatment. 1,8,9 However, little is known about risk factors for disease and better understanding of these risks might allow for targeted approaches to prevent ongoing pulmonary damage in pediatric patients who are at risk. 10,11 In particular, no prior studies have examined the gastrointestinal risk factors contributing to bronchiectasis; however, with the development of aerodigestive programs, the role of the gastroenterologist in multidisciplinary care has become more central to the diagnosis and management of these patients.…”

Childhood bronchiectasis, so little is known

“…Thomas et al 3 explore a possible aetiology of bronchiectasis by examining its association with tracheomalacia. Within a historical cohort in a single tertiary paediatric centre, the degree of tracheomalacia, defined while performing a flexible bronchoscopy, was compared in children with or without evidence of bronchiectasis on a conventional high-resolution CT (c-HRCT) image.…”

“…Although childhood bronchiectasis is still classed as a neglected orphan disease that we know so little about, through efforts such as those of Thomas et al 3 it may not be an orphan for much longer.…”