Tracheobronchomalacia in children

Abstract

Tracheobronchomalacia disorders present a considerable diagnostic challenge and workload to tertiary pediatrics. Bronchoscopy is the definitive way of confirming these diagnoses. Quantification of the size of lesions with a reference point is important to the decision-making processes for management, yet this aspect of assessment has been left to subjective visual estimates of size, even though there are now methods available for quantitative measurement. There is a wide range of bronchoscopic appearances and clinical manifestations of these disorders, and a spectrum of resultant diseases. At the mild end of the spectrum of illnesses, the clinical profiles are worse than similar respiratory illnesses in normal children. At the moderate and severe ends of the spectrum, invasive interventions, operative approaches and intensive care management are often necessary. Generally, these disorders are thought to improve with increasing age, but exactly which types and to what extent these disorders actually do improve or resolve are not known. Research is necessary to establish a true definition of these disorders to establish an improved understanding of the clinical profiles of the various appearance and types of malacia. Randomized, controlled studies of the management of malacia disorders, including research on potentially curative medical molecular genetic therapies, will be beneficial to pediatric respiratory medicine and ultimately the care of children with these disorders.