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Quantified tracheobronchomalacia disorders and their clinical profiles in children

¹Ian B Masters, MB BS, School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia. Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia. ²Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside 4032, Brisbane, Australia. ³Queensland Institute of Medical Research, Herston Rd, Herston 4029, Brisbane, Australia. ⁴School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia. Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia. ⁵University of Queensland, Department of Information Technology and Electrical Engineering, St Lucia 4072, Brisbane, Australia. ⁶School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia. Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia. Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0800, Australia.

brent_masters{at}health.qld.gov.au

Abstract

Background: Tracheobronchomalacia disorders in children have never been studied using quantified measurements and validated clinical outcome measures. The objectives were to prospectively examine the relationship between malacia lesions and their respiratory illness profiles.

Methods: The site of malacia lesions (tracheomalacia, tracheobronchomalacia, bronchomalacia) were determined, measured and related to its respective cricoid (airway to cricoid ratio) using the colour histogram mode technique. These children and normal controls were followed for 12 months with their respiratory illness profiles determined using Canadian Acute Respiratory Illness Scale (CARIFS) and cough diary scores.

Measurements: Outcome measures were respiratory illness frequency (over 12-months), severity score (day-1 CARIFS) and significant cough interfering with daily activity (score of 3) and illness resolution (time to return to a quarter of CARIFS-d1 score).

Results: The group of 116 children were comprised of malacia (n=81) and controls (n=35) cases. The median age of the group was 2.1 (range 0.2-17.3) years. The adjusted relative risk RR_adj (95%CI) of illness frequency was 2.1 (1.3-3.4) and significant cough was 7.2 (1.01-27.22) for the malacia group while CARIFS-d1 score was 1.66 (1.1-2.56) compared to controls. Illness resolution rates at day 14 in the malacia group trended 25% slower than controls. Malacia type and severity of lesions were not associated with increased rates of illness or worse clinical profiles.

Conclusion: Children with malacia have increased likelihood of respiratory illness frequency, severity, significant cough and a tendency for delayed recovery. However neither site nor severity of malacia exhibited any significant dose effect on respiratory illness profiles.

Key Words: tracheobronchomalacia • tracheomalacia • bronchomalacia