Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis

Abstract

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.

Non-Cystic Fibrosis Bronchiectasis in Pediatric Age: A Case Series in a Metropolitan Area of Northern Italy

“…Among our patients five children also had a history of recurrent wheezing during first years of life, many patients (73%) experienced wheezing during exacerbations and 6 had a diagnosis of asthma. Several studies have shown that, in daily medical practice, ICS with or without LABA, are commonly prescribed in patients with NCFB even without a diagnosis of coexisting asthma [ 29 ].…”

Pathophysiology of non-cystic fibrosis bronchiectasis in children and adolescents with asthma: A protocol for systematic review and meta-analysis

“…Both asthma and non-cystic fibrosis bronchiectasis are chronical diseases affecting pediatric population, with great impact in their quality of life, in addition to economic and financial impact to their family and health system [ 12 – 14 , 19 ]. Its association, despite being described in literature, requires better comprehension about the pathophysiology involved.…”

“…It is believed that non-cystic fibrosis bronchiectasis in children is caused by repeatedly episodes of external agents associated with genetic vulnerability, however, the other possible etiologies are poorly defined, with heterogeneous risk factors [ 4 , 10 ]. Diagnosis consists of evaluating the patient’s clinical condition and the results of computed tomography, but it is possible to observe that children with bronchiectasis also develop similar symptoms to asthma, which can be easily confused [ 4 , 11 – 14 ].…”

“…The association of these two diseases can result in more severe symptoms and a greater number of exacerbations [ 13 , 14 ], therefore, this systematic review is justified because we believe that by identifying, selecting and critically evaluating studies on asthma and bronchiectasis, would be possible to enlighten the characteristics of children and adolescents with associated diagnoses and provide information to help individualized treatments in order to control and prevent complications.…”

Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with Pseudomonas aeruginosa

“…Quite often the diagnosis of asthma is based on a therapeutic trial of ICS and an assessment of the child’s response. Nevertheless, this approach is not always helpful in children with bronchiectasis because of the confounding effect of co-administered drugs [ 26 ].…”