HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Boogaard, R. Articles by Merkus, P. J. F. M. Search for Related Content PubMed PubMed Citation Articles by Boogaard, R. Articles by Merkus, P. J. F. M.

Tracheomalacia and Bronchomalacia in Children^*

Incidence and Patient Characteristics

^* From Erasmus MC-Sophia Children’s Hospital, Erasmus University Medical Centre, Department of Pediatrics, Division of Pediatric Pulmonology, Rotterdam, the Netherlands.

Correspondence to: Ruben Boogaard, MD, Room Sb-2666, Sophia Children’s Hospital, Erasmus University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, the Netherlands; e-mail: r.boogaard{at}erasmusmc.nl

Objective: Congenital airway malacia is one of the few causes of irreversible airways obstruction in children, but the incidence in the general population is unknown. Severe airway malacia or malacia associated with specific syndromes is usually recognized and diagnosed early in infancy, but information about clinical features of children with primary malacia, often diagnosed only later in childhood, is scarce.

Methods: We analyzed all flexible bronchoscopies performed between 1997 and 2004 in the Sophia Children’s Hospital, summarized clinical features of children with primary airway malacia, estimated the incidence of primary airway malacia, and calculated the predictive value of a clinical diagnosis of airway malacia by pediatric pulmonologists.

Results: In a total of 512 bronchoscopies, airway malacia was diagnosed in 160 children (94 males) at a median age of 4.0 years (range, 0 to 17 years). Airway malacia was classified as primary in 136 children and secondary in 24 children. The incidence of primary airway malacia was estimated to be at least 1 in 2,100. When pediatric pulmonologists expected to find airway malacia (based on symptoms, history, and lung function) prior to bronchoscopy, this was correct in 74% of the cases. In 52% of the airway malacia diagnoses, the diagnosis was not suspected prior to bronchoscopy. Presenting clinical features of children with airway malacia were variable and atypical, showing considerable overlap with features of allergic asthma. Peak expiratory flow was more reduced than FEV₁.

Conclusion: Primary airway malacia is not rare in the general population, with an estimated incidence of at least 1 in 2,100 children. Airway malacia is difficult to recognize based on clinical features that show overlap with those of more common pulmonary diseases. We recommend bronchoscopy in patients with impaired exercise tolerance, recurrent lower airways infection, and therapy-resistant, irreversible, and/or atypical asthma to rule out airway malacia.

Key Words: bronchomalacia • bronchoscopy • child • diagnosis • difficult asthma • incidence • lung function • symptoms • tracheomalacia

This article has been cited by other articles:

				E. Yalcin, D. Dogru, U. Ozcelik, and N. Kiper Airway malacia disorders in children. Chest, July 1, 2006; 130(1): 304 - 304. [Full Text] [PDF]