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. 2022 Jun;107(6):565-569.
doi: 10.1136/archdischild-2021-322578. Epub 2021 Oct 14.

Association of childhood tracheomalacia with bronchiectasis: a case-control study

Rahul Thomas  1   2 , Anne Chang  3   2   4 , Ian Brent Masters  3   2 , Keith Grimwood  5   6   7 , Julie Marchant  3   2 , Stephanie Yerkovich  3   4 , Mark Chatfield  8 , Christopher O'Brien  9 , Vikas Goyal  3   2   7
Affiliations

Association of childhood tracheomalacia with bronchiectasis: a case-control study

Rahul Thomas et al. Arch Dis Child. 2022 Jun.

Abstract

Objective: Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis.

Design: Single-centre, case-control study.

Setting and patients: 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT.

Interventions: The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area).

Main outcome measures and results: Cases were younger (median age=2.6 years, IQR 1.5-4.1) than controls (7.8 years, IQR 3.4-12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity).

Conclusion: Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.

Keywords: paediatrics; respiratory medicine.

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Conflict of interest statement

Competing interests: RT has a postgraduate scholarship (for PhD) from National Health and Medical Research Council, Australia (APP1190908) and PhD top-up scholarship from Children’s Health Foundation, Queensland (RPC00072) during the conduct of the study. AC has received grants from National Health and Medical Research Council, Australia (NHMRC) and other fees to the institution from work relating to being an IDMC member of an unlicensed vaccine (GSK) and an advisory member of study design for unlicensed molecule for chronic cough (Merck) outside the submitted work.

Comment in

  • Childhood bronchiectasis, so little is known.
    Carr SB, Unger SA. Carr SB, et al. Arch Dis Child. 2022 Jun;107(6):523-524. doi: 10.1136/archdischild-2021-323721. Epub 2022 Mar 22. Arch Dis Child. 2022. PMID: 35318195 No abstract available.

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