Allergy Asthma Immunol Res.  2011 Jan;3(1):39-45. 10.4168/aair.2011.3.1.39.

Bronchiectasis in Children: 10-Year Experience at a Single Institution

• Kim HY
• Kwon JW
• Seo J
• Song YH
• Kim BJ
• Yu J
• Hong SJ

• KMID: 2260376
• DOI: http://doi.org/10.4168/aair.2011.3.1.39

Abstract

PURPOSE
Bronchiectasis in children is still one of the most common causes of childhood mortality in developing countries. The aim of this study was to investigate the epidemiological characteristics, clinical features, underlying etiologic factors, and distinct change in the management of patients with bronchiectasis at Asan Medical Center Children's Hospital of Seoul.
METHODS
A retrospective study of children diagnosed with bronchiectasis was conducted between January 1999 and December 2008. All patients underwent a comprehensive examination to identify etiologic factors. Data analysis in terms of age at onset, initial presenting symptoms, underlying etiology, distinct change in treatment, distribution of pulmonary involvement on computed tomography (CT), and causative microbiological flora triggering secondary infections was performed.
RESULTS
The median age at the time of the diagnosis of bronchiectasis was 7.6 years (range, 2 months to 18 years). Persistent coughing was the most common symptom. The underlying etiologies identified in 79 patients (85.8%) included bronchiolitis obliterans (32.6%), childhood respiratory infection (20.6%), interstitial lung disease (17.3%), immunodeficiency (8.6%), and primary ciliary dyskinesia (4.3%). In 53 children (67%), the identified cause led to a distinct and individualized change in management. The distribution of CT abnormalities had no correlation with the underlying cause of bronchiectasis.
CONCLUSIONS
Selected Korean children with bronchiectasis were reviewed to identify diverse underlying etiologies. All children with bronchiectasis should be comprehensively investigated because identifying underlying causes may have a major impact on their management and prognosis.

Keyword

Bronchiectasis; etiology; bronchiolitis obliterans; infection; child

MeSH Terms

Bronchiectasis
Bronchiolitis Obliterans
Child
Coinfection
Cough
Developing Countries
Humans
Kartagener Syndrome
Lung Diseases, Interstitial
Prognosis
Retrospective Studies
Statistics as Topic

Reference

1. Balkanli K, Genç O, Dakak M, Gürkök S, Gözübüyük A, Caylak H, Yücel O. Surgical management of bronchiectasis: analysis and short-term results in 238 patients. Eur J Cardiothorac Surg. 2003. 24:699–702.

2. Singleton R, Morris A, Redding G, Poll J, Holck P, Martinez P, Kruse D, Bulkow LR, Petersen KM, Lewis C. Bronchiectasis in Alaska native children: causes and clinical courses. Pediatr Pulmonol. 2000. 29:182–187.

3. Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax. 2004. 59:324–327.

4. Li AM, Sonnappa S, Lex C, Wong E, Zacharasiewicz A, Bush A, Jaffe A. Non-CF bronchiectasis: does knowing the aetiology lead to changes in management? Eur Respir J. 2005. 26:8–14.

5. Hansell DM. Bronchiectasis. Radiol Clin North Am. 1998. 36:107–128.

6. Brody AS. Cystic fibrosis: when should high-resolution computed tomography of the chest be obtained? Pediatrics. 1998. 101:1071.

7. Ferkol TW, Davis PB. Taussig LM, Landau LI, Le Souëf PN, Morgan WJ, Martinez FD, Sly PD, editors. Bronchiectasis and bronchiolitis obliterans. Pediatric respiratory medicine. 1999. St Louis: Mosby;784–789.

8. Karakoc GB, Yilmaz M, Altintas DU, Kendirli SG. Bronchiectasis: still a problem. Pediatr Pulmonol. 2001. 32:175–178.

9. Brown MA, Lemen RJ. Chernick V, Boat TF, Kendig EL, editors. Bronchiectasis. Kendig's disorders of respiratory tract in children. 1998. 6th ed. Philadelphia: Saunders;538–552.

10. Lewinston NJ. Hilman BC, editor. Bronchiectasis. Pediatric respiratory disease: diagnosis and treatment. 1993. Philadelphia: Saunders;222–229.

11. Dagli E. Non cystic fibrosis bronchiectasis. Paediatr Respir Rev. 2000. 1:64–70.

12. Reiff DB, Wells AU, Carr DH, Cole PJ, Hansell DM. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol. 1995. 165:261–267.

13. Kennedy MP, Noone PG, Leigh MW, Zariwala MA, Minnix SL, Knowles MR, Molina PL. High-resolution CT of patients with primary ciliary dyskinesia. AJR Am J Roentgenol. 2007. 188:1232–1238.

14. Curtin JJ, Webster AD, Farrant J, Katz D. Bronchiectasis in hypogammaglobulinaemia--a computed tomography assessment. Clin Radiol. 1991. 44:82–84.

15. Lee PH, Carr DH, Rubens MB, Cole P, Hansell DM. Accuracy of CT in predicting the cause of bronchiectasis. Clin Radiol. 1995. 50:839–841.

16. Cartier Y, Kavanagh PV, Johkoh T, Mason AC, Müller NL. Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases. AJR Am J Roentgenol. 1999. 173:47–52.

17. King P, Holdsworth S, Freezer N, Holmes P. Bronchiectasis. Intern Med J. 2006. 36:729–737.

18. Hill SL, Mitchell JL, Burnett D, Stockley RA. IgG subclasses in the serum and sputum from patients with bronchiectasis. Thorax. 1998. 53:463–468.

19. Karadag B, Karakoc F, Ersu R, Kut A, Bakac S, Dagli E. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration. 2005. 72:233–238.

20. Buchdahl RM, Reiser J, Ingram D, Rutman A, Cole PJ, Warner JO. Ciliary abnormalities in respiratory disease. Arch Dis Child. 1988. 63:238–243.

21. Karakoc F, Cakir E, Ersu R, Uyan ZS, Colak B, Karadag B, Kiyan G, Dagli T, Dagli E. Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms. Int J Pediatr Otorhinolaryngol. 2007. 71:241–246.

22. Karakoç F, Karadağ B, Akbenlioğlu C, Ersu R, Yildizeli B, Yüksel M, Dali E. Foreign body aspiration: what is the outcome? Pediatr Pulmonol. 2002. 34:30–36.

23. Edwards EA, Metcalfe R, Milne DG, Thompson J, Byrnes CA. Retrospective review of children presenting with non cystic fibrosis bronchiectasis: HRCT features and clinical relationships. Pediatr Pulmonol. 2003. 36:87–93.

24. Tsang KW, Ho PI, Chan KN, Ip MS, Lam WK, Ho CS, Yuen KY, Ooi GC, Amitani R, Tanaka E. A pilot study of low-dose erythromycin in bronchiectasis. Eur Respir J. 1999. 13:361–364.

25. Koh YY, Lee MH, Sun YH, Sung KW, Chae JH. Effect of roxithromycin on airway responsiveness in children with bronchiectasis: a double-blind, placebo-controlled study. Eur Respir J. 1997. 10:994–999.

26. Tsang KW, Ho PL, Lam WK, Ip MS, Chan KN, Ho CS, Ooi CC, Yuen KY. Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis. Am J Respir Crit Care Med. 1998. 158:723–727.

27. Kolbe J, Wells A, Ram FS. Inhaled steroids for bronchiectasis. Cochrane Database Syst Rev. 2000. CD000996.

28. Callahan CW, Redding GJ. Bronchiectasis in children: orphan disease or persistent problem? Pediatr Pulmonol. 2002. 33:492–496.

29. Kutlay H, Cangir AK, Enön S, Sahin E, Akal M, Güngör A, Ozdemir N, Kavukçu S. Surgical treatment in bronchiectasis: analysis of 166 patients. Eur J Cardiothorac Surg. 2002. 21:634–637.

30. Sirmali M, Karasu S, Türüt H, Gezer S, Kaya S, Taştepe I, Karaoğl anoğlu N. Surgical management of bronchiectasis in childhood. Eur J Cardiothorac Surg. 2007. 31:120–123.