Application of Flexible Bronchoscopy in the Aetiological Diagnosis of Childhood Refractory Wheezing

Objective: To explore the value of flexible bronchoscopy in aetiological diagnosis of paediatric refractory wheezing. Methods: A total of 246 patients with refractory wheezing performed flexible bronchoscopy were analysed. They were 146 males and 100 females with a ratio of male to female 1.5:1. Their age ranged from 1 month to 9 years with a median age of 17 months. Results: Flexible bronchoscopy was performed 269 times. By bronchoscopy, mucus plug was found in 52 patients (21.1%), airway malacia in 76 (30.9%), structural deformity in 32 (13.0%), foreign bodies in 22 (8.9%), tuberculosis in 3 and tumor in one. The aetiology of refractory wheezing varied with different ages. Airway malacia (61.2%) was the main reason in infants, then mucus plug (15.3%). Among toddlers, the most common reason was mucus plug (24.5%), followed by airway malacia (15.1%) and foreign body (14.2%). Bronchoalveolar lavage demonstrated pathogens in 17 (17.3%) of 98 samples. The most common complication was hypoxia during the procedures. They all were transient and alleviated by oxygen supplement or temporary cessation of the procedure. Conclusion: Flexible bronchoscopy is effective in the aetiological diagnosis of childhood refractory wheezing. Mucus plug, airway malacia, structural deformities and foreign body are the main reasons for childhood refractory wheezing.