Non-cystic fibrosis bronchiectasis occurs in pediatric patients and results in chronic lung disease marked by recurrent lung infections. Chronic pulmonary aspiration (CPA) may cause only 5% of cases. The purpose of this study is to describe the prevalence, clinical correlates, and risk factors for bronchiectasis in children with CPA.
Medical records were reviewed for all patients with CPA seen in our airway center from July 2006- March 2009. All patients underwent rigid and flexible bronchoscopy, high resolution CT (HRCT) of the chest, and at least one swallow study at the time of evaluation. Diagnosis of CPA was made by either a positive swallow study or the finding of a laryngeal cleft or tracheoesophageal fistula. Summary statistics were performed to describe the prevalence of bronchiectasis in this group and additional risk factors were identified. Airway inflammation and infection were compared between those with and without bronchiectasis.
Fifty-two subjects were identified with a median age of 30 months (range 6 months–18 years). Overall, 36 (69%) had bronchiectasis on initial evaluation, including 68% of those <2 years old. The youngest was 8 months. 78% had bronchiectasis in multiple lobes and in 71% it was bilateral. Right upper, right lower, and left lower lobes were most commonly affected. Thirteen subjects had repeat HRCT: 5 demonstrated improvement/resolution of bronchiectasis, 4 were stable, and 4 progressed. Central nervous system (CNS) disease (OR 6.8, p=0.009) and past history of gastroesophageal reflux (GER) (OR 4.6, p=0.03) were identified as risk factors; age, gender, recurrent pneumonia, tracheostomy, and prematurity were not. Most subjects had increased airway neutrophils (78%) and there was no difference in airway inflammation or infection between those with and without bronchiectasis.
CPA results in chronic airway inflammation and bronchiectasis. This develops at a very young age and is more likely in those with GER or CPA due to CNS disease.
Early identification of bronchiectasis in this population may alter treatment and improvement or resolution is achievable.
Joseph Piccione, No Financial Disclosure Information; No Product/Research Disclosure Information