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March 1997
Primary bronchomalacia in infants and children.
Finder, JD. J Pediatr 1997; 130:59-66.
[ no abstract available ]
In pediatric anesthesia one is from time to time presented with an infant with wheezing that persists despite what appears to be adequate medical therapy. We are all used to thinking of tracheomalacia as a cause of persistent upper airway sounds (stridor) in infants, but the etiology of persistent lower airway sounds (wheezing) has been less well defined.
In this paper, Dr. Finder has reviewed the records of 17 patients at the Children's Hospital of Pittsburgh with bronchoscopically confirmed primary bronchomalacia as the cause of their persistent wheezing and followed up on their clinical courses. All the patients had the onset of their symptoms in the first 6 months of life and had been diagnosed as having reactive airways disease (RAD) and/or gastro-esophageal reflux. All had had a poor response to medical therapy for these conditions and most have abnormal exercise tolerance and poor clearance of secretions. Most patients with this disorder as the sole cause of their wheezing (those without associated RAD) have substantial improvement in their symptoms by 5 years of age.
Recognition of this disorder can be important for physicians who anesthetize children in that patients with primary bronchomalacia have abnormal exercise tolerance. They could be expected to have more perioperative respiratory complications, especially in the presence of an associated upper respiratory infection, than patients with normal bronchial anatomy.
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