P138 Outcomes of children undergoing clinically indicated bronchoscopy for severe recurrent respiratory symptoms

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Introduction Severe childhood wheeze, cough and lower respiratory tract infections (LRTI) are often managed empirically with inhaled corticosteroids (ICS) and/or antibiotics based on symptoms alone. We investigated the following outcomes associated with targeted treatment determined by bronchoalveolar lavage (BAL) results: episode frequency, prescribed treatment, diagnosis and long-term outcomes in children undergoing clinically indicated bronchoscopy. Methods Retrospective case-note review of 116 children aged 1–17 years who underwent elective, clinically indicated bronchoscopy between 2016–2024 for severe wheeze/asthma, recurrent cough and/or LRTI. Results 70/116 (60.3%) children were preschool age (<6 years). 74/116 (63.8%) children had BAL-positive bacterial cultures; 52/70 (74.3%) were preschool and 22/46 (47.8%) were school-age. BAL bacterial pathogens differed significantly between preschool and school-age: Moraxella catarrhalis (33.3%), Haemophilus influenzae (29.3%) and Streptococcus pneumoniae (17.3%) were most common in preschool, while Staphylococcus aureus (36%) was most common in school-age children. All BAL bacterial positive children received a minimum of 2 weeks targeted antibiotics post-bronchoscopy. Rhinovirus, enterovirus and adenovirus were the most detected viruses across all ages. 12-month follow-up data were obtained from 70/116 (60.3%) children. Median annual episodes reduced from 6 pre-bronchoscopy, to 2 in 75% of preschool children, and from 6.5 to 3.5 in 25% of school-age children. 17/49 (34.7%) preschool children had symptom improvement/resolution (P<0.0001) in the 12 months after bronchoscopy; 12/49 (24.5%) had new diagnoses of aspiration syndromes. In all children 12 months post-bronchoscopy, prophylactic antibiotic use increased from 18/70 (25.7%) to 35/70 (50%) (P<0.01); aspiration as an indication increased from 0% to 8/35 (22.9%) (P<0.05). 110 children were followed up to final/most recent visit (median 33 months post-bronchoscopy). LRTI diagnoses decreased from 72/110 (65.5%) pre-bronchoscopy to 22/110 (20%) by the final visit (P<0.0001). Asthma/wheeze diagnoses increased from 4/110 (3.6%) to 16/110 (14.5%) at the last visit (P<0.0001). 14 patients had aspiration diagnoses by the final visit compared to none pre-bronchoscopy (P<0.0001). 44/97 (45.4%) children were discharged after median follow-up of 17.5 months. Conclusion Bronchoscopy with BAL informs targeted treatment in children with complex respiratory symptoms and LRTI diagnoses. Nearly half of patients achieved symptom resolution and were discharged from tertiary care at approximately three years after the procedure.

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