Is there an association between tracheomalacia and bronchiectasis in children?

Abstract

Introduction: Tracheomalacia is associated with chronic lower airway infection and inflammation. It is plausible that children with tracheomalacia are at risk of developing bronchiectasis. We hypothesised that compared to controls, tracheomalacia in children is associated with bronchiectasis. Methods: We undertook a case-control study of 45 children with chest high-resolution computed tomography (c-HRCT) proven bronchiectasis (Brisbane children enrolled in the Australian Bronchiectasis Registry) and 90 children undergoing c-HRCT for febrile neutropaenia and without radiographic signs of bronchiectasis. Both cases and controls had flexible bronchoscopy performed within 4-weeks of their c-HRCT and bronchoscopy video recordings were reviewed in a blinded manner for (a) any tracheomalacia (any shape deformity of the trachea at end expiration) and (b) tracheomalacia as defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area). Results: The controls were older (median age=93.5 months, IQR 41.0-152.5) than cases (31.0 months, 18.0-49.0). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted odds ratio [adjOR]=13.2, 95%CI 3.2-55.0), whilst that for ERS-defined tracheomalacia further increased this risk (adjOR=20.2, 95%CI 2.3-174.2). Conclusion: Bronchoscopically-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic wet cough, the most common symptom of bronchiectasis, which if present should be treated and investigated if the cough persists or is recurrent.L6381960462022-06-14 <br />