title: Bronchoscopy contributes to the clinical management of indigenous children newly diagnosed with bronchiectasis.
abstract: BACKGROUND
  Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.
  
  
  OBJECTIVE
  To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.
  
  
  METHODS
  We examined FB and BAL data collected prospectively in 56 children aged 0.8-9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >10(4) colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.
  
  
  RESULTS
  Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%).
  
  
  CONCLUSIONS
  Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. susan.pizzutto@menzies.edu.au
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pizzutto
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
authors.forename: Paul
authors.initials: P
authors.lastname: Bauert
authors.forename: Kobi L
authors.initials: KL
authors.lastname: Schutz
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Yerkovich
authors.forename: John W
authors.initials: JW
authors.lastname: Upham
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001987:Bronchiectasis / Q000175:diagnosis / Q000628:therapy; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D000081034:Indigenous Peoples