Bronchiectasis in chronic pulmonary aspiration: risk factors and clinical implications.
BACKGROUND
Bronchiectasis is a well-known sequela of chronic pulmonary aspiration (CPA) that can result in significant respiratory morbidity and death. However, its true prevalence is unknown because diagnosis requires high resolution computed tomography which is not routinely utilized in this population. This study describes the prevalence, time course for development, and risk factors for bronchiectasis in children with CPA.


METHODS
Using a cross-sectional design, medical records were reviewed for all patients with swallow study or airway endoscopy-confirmed aspiration in our airway center over a 21 month period. All patients underwent rigid and flexible bronchoscopy, and high resolution chest computed tomography. Prevalence, distribution, and risk factors for bronchiectasis were identified.


RESULTS
One hundred subjects age 6 months to 19 years were identified. Overall, 66% had bronchiectasis, including 51% of those less than 2 years old. The youngest was 8 months old. Severe neurological impairment (OR 9.45, P<0.004) and history of gastroesophageal reflux (OR 3.36, P=0.036) were identified as risk factors. Clinical history, exam, and other co-morbidities did not predict bronchiectasis. Sixteen subjects with bronchiectasis had repeat chest computed tomography with 44% demonstrating improvement or resolution.


CONCLUSIONS
Bronchiectasis is highly prevalent in children with CPA and its presence in young children demonstrates that it can develop rapidly. Early identification of bronchiectasis, along with interventions aimed at preventing further airway damage, may minimize morbidity and mortality in patients with CPA.
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
Joseph C
JC
Piccione
Gary L
GL
McPhail
Matthew C
MC
Fenchel
Alan S
AS
Brody
Richard P
RP
Boesch
D000293:Adolescent; D001987:Bronchiectasis / Q000175:diagnosis / Q000453:epidemiology*; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D053120:Respiratory Aspiration / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult