Is there an association between tracheomalacia and bronchiectasis in children?

Abstract

Introduction/Aim: As tracheomalacia impairs mucociliary clearance, it can lead to ongoing lower airway infection and inflammation. Therefore, it is biologically plausible that children with tracheomalacia are at risk of developing bronchiectasis (BE). We assessed the association between tracheomalacia and bronchiectasis.

Methods: A retrospective case control study was conducted. ‘Cases' (n=45) were children with bronchiectasis (randomly selected from the Australian Bronchiectasis Registry) and ‘controls’ (n=90) were children with no bronchiectasis, based on chest high-resolution computed tomography (HRCT) (children with oncological conditions who had FB and chest HRCT for febrile neutropenia workup). Both cases and controls had flexible bronchoscopy (FB) within a month of chest HRCT. The FB recordings were scored in a random order by expert respiratory paediatricians (blinded to the history) for presence or absence of tracheomalacia in two different ways (presence of any tracheomalacia [Any-TM] and presence of tracheomalacia according to the definition used by the European Respiratory Society (ERS) statement on tracheomalacia and bronchomalacia in children [ERS-TM]). Regression analyses was used to adjust for baseline characteristics.

Results: The median age of the ‘control’ group was 93 months (IQR = 41-152) and the median age of the ‘cases’ group was 31 months (IQR = 18-49). 17 patients had tracheomalacia according to the Any-TM definition and 9 patients had tracheomalacia according to the ERS-TM definition. Multivariate analysis (table below) revealed that the ORadj of having BE was 13 (95%CI 3-55, p<0.001) for presence of Any-TM. When analysed based on ERS-TM, ORadj increased to 20 (95%CI 2-174, p=0.006).

Conclusion: Children with tracheomalacia (diagnosed on FB) are much more likely to have bronchiectasis than those without tracheomalacia. We suggest a proactive approach with regular follow-up in a multidisciplinary team, in the management of children with tracheomalacia.

Grant Support: NHMRC and CHQ postgraduate scholarships (RJT), NHMRC practitioner fellowship (ABC)