When should we perform flexible bronchoscopy in children with recurrent lower respiratory tract infections (RLTI)?

Abstract

Many children experience RLTI. Physicians have to distinguish healthy subjects from those with an underlying chronic disease that requires further investigations.The aim of the study is to evaluate the need of flexible bronchoscopy (FB) in children with RLTI It is a retrospective study among 76 children who consulted our daycare hospital from 2013 to 2015 for RLTI.Every patient had a physical examination,blood count,prick-tests,chest radiography,an EGD-transit or an oesophageal ultrasound and a spirometry. Asthma,gastro esophageal reflux(GER) or upper respiratory tract infections were diagnosed in 57 children who didn9t need further examinations. twenty subjects (26.31%) underwent a FB.It was made immediately in 4 children with bronchiectasis because of abnormal chest x ray. Sixteen FB were made in children with uncontrolled asthma(3 cases),unexplained RLTI (11 cases) or persistent cough after GER treatment(2 cases).FB was normal in 8 children(6 with RLTI).The FB showed tracheal dyskinesia in 2 children with unexplained RLTI. Bacteriological examination of sputum aspirate was performed in 13 subjects and it was positif in 7 of them. Haemophilus Influenzae was isolated in 5 cases (1asthma,1GER,2bronchiectasis,2 unexplained RLTI) and streptococcus pneumonia in 1 case with RLTI. After antibiotic treatment there was an improvement in children with RLTI suggesting the diagnosis of protracted bacterial bronchitis. FB must be performed in case of unexplained RLTI,uncontrolled asthma or in presence of persistent chest x ray abnormalities. It also allows bacteriological analysis and thus to diagnose protracted bacterial bronchitis that is usually under-recognized.