Management of the Chronically Inflamed Pediatric Airway

Abstract

Objective: To examine our initial experience with the use of azithromycin in children with airway stenosis and chronically inflamed airways. Method: This retrospective study examined 20 children with airway stenosis and chronically inflamed airways. Patients tested negative for eosinophilic esophagitis and gastroesophageal reflux and took azithromycin (10 mg/kg) 3 times per week for at least a 1-month period. Outcomes were status of airway inflammation after azithromycin and decision to intervene on airway stenosis. Results: The mean age was 3.6 years (range 0.9-8.0) with 13 females and 7 males. Diagnoses included subglottic stenosis (85%), tracheal stenosis (5%), bronchial stenosis (5%), and bilateral vocal cord paralysis (5%). Mean duration of azithromycin therapy was 116.6 days (range 42-192). Airway inflammation improved in 14 patients (70%) allowing successful airway intervention in 12 patients. Two did not undergo surgery due to reasons other than airway inflammation. Six patients had persistent inflammation, 5 of whom are currently being observed. Conclusion: Children with airway stenosis and chronic inflammation pose significant challenges for the airway surgeon. Our initial experience suggests that azithromycin can reduce airway inflammation, allowing one to proceed with surgical intervention. Further studies evaluating azithromycin are warranted.