Diagnostic yield of flexible bronchoscopy and bronchoalveolar lavage in children with chronic cough.

Le résumé fourni par la source

Introduction: Chronic cough is defined as a daily cough lasting more than 4 weeks. Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) allows for detailed airway assessment, BAL fluid analysis and microbiological studies. It is recommended in the current diagnostic pathway for unexplained chronic cough. Objectives: This study aimed to describe clinical features, FB and BAL findings in children with chronic cough. Methods: Retrospective review of children who underwent FB and BAL for chronic cough or a history of more than 3 episodes of chronic wet cough in a single centre in South Africa between 2015 to 2021. Results: 77 patients (mean age 5.1) were included. 21 (27%) patients had more than 3 episodes of chronic cough in 12 months. Clinical features included wet cough (83%), wheeze (61%), atopy (16%) and chronic inhaled corticosteroid use (60%). 20 (26%) patients had lower airway anatomical abnormalities. 57% and 16% had an increased neutrophil and eosinophil % in BAL fluid (BALf) respectively. In 45% at least one bacteria was isolated and 37% had at least one positive viral PCR. The most common bacteria were H. influenzae (26%), S. pneumoniae (10%) and M. catarrhalis (8%). Mycobacterial cultures were negative. The BALf neutrophil % was correlated with a positive bacterial culture (p=0.002). Eosinophilic inflammation in BALf was associated with blood eosinophilia (p=0.044). Conclusion: Flexible bronchoscopy identified an anatomical airway abnormality in a quarter of all patients. A BALf neutrophil percentage >5% is strongly correlated with bacterial infection. These findings support the current guidelines for the role of flexible bronchoscopy and BAL in chronic cough.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.