The role of Flexible bronchoscopy in the evaluation and outcome of children with chronic cough: 20-year experience

Abstract

<b>Background:</b> While some diagnoses of chronic cough in children are made by careful history alone, others require further investigations. Flexible fibreoptic bronchoscopy has been an important tool to identify the etiology of chronic cough that is not otherwise apparent. <b>Methods:</b> Over 20 years, we evaluated retrospectively a population of 176 children with chronic cough not related to asthma who were referred to a specialized center (2012-2021). All patients were evaluated with chest radiographs (CXRs), spirometry, HRCT scanning, and FB/BAL. <b>Results:</b> We evaluated 176 children with chronic cough (53% males, median age six years, 1 -to 18 years), median BMI 17.8kg/m2), mean (SD) FEV1pp 89.3 (35) %. Flexible bronchoscopy indicated the etiology of chronic cough in 84% of the cases; diagnosis included: tracheobronchomalacia (14%), bronchomalacia (13%), tracheomalacia (14%), laryngomalacia (6.5%), stenosis of the RML bronchus (12.5%), other congenital anomalies of the trachea-bronchial tree (12%), suspicion of vascular ring (1%), inflammation of the airways &amp; secretions of the airways (11%) and normal findings (16%). Following the diagnosis, the children received appropriate treatment. As a result, the symptoms were significantly improved and follow-up spirometry indices were also significantly improved 1.6years later (mean (SD) ΔFVCpp 25.6 (13), ΔFEV1pp 25.8 (11), p&lt;0.001. <b>Conclusions:</b> Pediatric FB is an essential tool for diagnosing children with chronic cough. Underline anatomical conditions were found in many children with chronic cough, significantly impacting further patient management.