Value Of Bronchoscopy In The Diagnosis And Treatment Of Repeated Or Persistent Wheezing In Infants And Young Children

PART ONE DIAGNOSTIC VALUE OF BRONCHOSCOPYIN INFANTS AND YOUNG CHILDREN WITH REPEATEDOR PERSISTENT WHEEZINGObjective： To investigate the diagnostic value of fiberoptic bronchoscopyin infants and young children with repeated or persistent wheezing.Methods：237cases of hospitalized infants and young children withrecurrent wheezing (≥3times) or persistent wheezing (≥4weeks) whohad no significant improvement after conventional diagnosis and treatmentunderwent bronchoscopy to observe the changes in the tracheobronchiallumen. Infants and young children with tracheobronchial abnormalitieswere followed up for1-2years.Results： In the237cases,39diagnosed as tracheobronchomalacia,10cases of tracheobronchial stenosis, open anomalies in12cases, bronchialtube oppression of2cases,2cases of tracheal diverticulum, bronchialcartilage rings in1cases,5cases of bronchial foreign body, endobronchial tuberculosis in2cases. In the237cases,42cases (75%) had singleabnormalities, while14cases (25%) had complex abnormalities.51caseswith tracheobronchial abnormalities were followed up for1-2years,8ofthe51cases were diagnosed as bronchial asthma.Conclusion：1) In infants and young children, besides bronchial asthma,congenital airway abnormalities such as tracheobronchomalacia,tracheobronchial stenosis and opening abnormalities are also commoncauses of repeated or persistent wheezing. And these factors can existtogether.2) Bronchoscopy is a means of diagnosis of a variety ofcongenital airway abnormalities. Most importantly, it is the gold standardmethod to diagnosis tracheobronchomalacia.3) Congenital airwayabnormalities also can combined presence with bronchial asthma. PART TWO APPLICATION VALUE OF FIBERBRONCHOSCOPE IN TREATMENT OF INFANTS WITHRECURRENT OR PERSISTENT WHEEZING.Objective： The study was performed to determine the therapeutic use offlexible bronchoscopy in infants with recurrent or persistent wheezing.Methods：303(161boys and142girls) patients with recurrent wheezing(≥3times) or persistent wheezing (≥4weeks) were enrolled in the study,and the age for the onset of the symptoms was ranged from1month to3years, and the wheezing episode duration was ranged from7days to3months, and pneumonia was diagnosed by chest X ray or chest CTscanning in all subjects which were exclude airway foreign by chest CTscanning three-dimensional airway reconstruction. All the subjects weredivided into treatment group and control group. The control group(141cases) was received routine therapy as antibiotics, steroids andbronchodilators, and the treatment group received flexible bronchoscopeperformance, by which alveolar lavage was carried out with1.25%metronidazole, ambroxol and budesonide once or twice as well as routinetherapy. Therapeutic effects were compared in5-7days after treatment.Results： There were no significant differences of age and clinical coursebetween these2groups. Among the control group (147cases),78caseswere cured,56cases were mend,13cases were failed, and among the treatment group (156cases),124cases were cured,28cases were mend,4cases were failed. The cure rate was significantly higher in treatment groupthan control group (79.5%vs53.1%, p<0.05).Conclusion： Bronchoalveolar lavage by bronchoscopes is an effectivetherapy for infants with recurrent or persistent wheezing, which is worth ofclinical application and popularization.