Tracheomalacia and bronchomalacia in children: incidence and patient characteristics.
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 FEV(1).


CONCLUSIONS
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.
Boogaard
Ruben
R
Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Centre, Department of Pediatrics, Division of Pediatric Pulmonology, Rotterdam, the Netherlands. r.boogaard@erasmusmc.nl
Huijsmans
Sjoerd H
SH
Pijnenburg
Marielle W H
MW
Tiddens
Harm A W M
HA
de Jongste
Johan C
JC
Merkus
Peter J F M
PJ
D000293:Adolescent; D001982:Bronchial Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D001992:Bronchoalveolar Lavage Fluid; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000453:epidemiology; D014133:Tracheal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*