Bronchoscopy contributes to the clinical management of Indigenous children newly diagnosed with bronchiectasis

Susan Pizzutto, Keith Grimwood, Paul Bauert, Kobi Louise Schutz, Stephanie Yerkovich, John Upham, Anne Chang

    Research output: Contribution to journalArticleResearchpeer-review

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    Abstract

    Background: Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.

    Objective: 
    To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.

    Method: 
    We examined FB and BAL data collected prospectively in 56 children aged 0.8–9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >104 colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.

    Results: 
    Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%).

    Conclusion: 
    Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.
    Original languageEnglish
    Pages (from-to)67-73
    Number of pages7
    JournalPediatric Pulmonology
    Volume48
    Issue number1
    Early online dateMar 2012
    DOIs
    Publication statusPublished - Jan 2013

    Fingerprint

    Bronchiectasis
    Bronchoscopy
    Bronchoalveolar Lavage
    Eosinophilia
    Fibrosis
    Strongyloides
    Anti-Bacterial Agents
    Bronchoalveolar Lavage Fluid
    Airway Obstruction
    Serology
    Foreign Bodies
    Microbiology
    Eosinophils
    Stem Cells
    Pediatrics

    Cite this

    Pizzutto, Susan ; Grimwood, Keith ; Bauert, Paul ; Schutz, Kobi Louise ; Yerkovich, Stephanie ; Upham, John ; Chang, Anne. / Bronchoscopy contributes to the clinical management of Indigenous children newly diagnosed with bronchiectasis. In: Pediatric Pulmonology. 2013 ; Vol. 48, No. 1. pp. 67-73.
    @article{7c2f65a2e8a4434e819b68d7f1b590db,
    title = "Bronchoscopy contributes to the clinical management of Indigenous children newly diagnosed with bronchiectasis",
    abstract = "Background: Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.Objective: To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.Method: We examined FB and BAL data collected prospectively in 56 children aged 0.8–9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5{\%}), or (3) BAL fluid culture >104 colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.Results: Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34{\%}) children, BAL microbiology results led to antibiotic changes in 5 (9{\%}) and an unsuspected foreign body was found in another (2{\%}). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42{\%}).Conclusion: Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.",
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    author = "Susan Pizzutto and Keith Grimwood and Paul Bauert and Schutz, {Kobi Louise} and Stephanie Yerkovich and John Upham and Anne Chang",
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    Bronchoscopy contributes to the clinical management of Indigenous children newly diagnosed with bronchiectasis. / Pizzutto, Susan; Grimwood, Keith; Bauert, Paul; Schutz, Kobi Louise; Yerkovich, Stephanie; Upham, John; Chang, Anne.

    In: Pediatric Pulmonology, Vol. 48, No. 1, 01.2013, p. 67-73.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Bronchoscopy contributes to the clinical management of Indigenous children newly diagnosed with bronchiectasis

    AU - Pizzutto, Susan

    AU - Grimwood, Keith

    AU - Bauert, Paul

    AU - Schutz, Kobi Louise

    AU - Yerkovich, Stephanie

    AU - Upham, John

    AU - Chang, Anne

    PY - 2013/1

    Y1 - 2013/1

    N2 - Background: Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.Objective: To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.Method: We examined FB and BAL data collected prospectively in 56 children aged 0.8–9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >104 colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.Results: Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%).Conclusion: Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.

    AB - Background: Some pediatric centers perform flexible bronchoscopy (FB) routinely when bronchiectasis is suspected. However, there are no published data evaluating this practice.Objective: To evaluate the contribution of FB and bronchoalveolar lavage (BAL) to the initial management of children newly diagnosed with non-cystic fibrosis (CF) bronchiectasis.Method: We examined FB and BAL data collected prospectively in 56 children aged 0.8–9.8 years during initial investigations for bronchiectasis. Investigations contributed to management if any of the following were identified: (1) airway obstruction requiring additional intervention, (2) lower airway eosinophilia (BAL eosinophils >2.5%), or (3) BAL fluid culture >104 colony-forming units/ml of a respiratory bacterial pathogen requiring change from usual empiric antibiotics.Results: Of the 56 children undergoing FB, there were 25 occasions in 23 children where these procedures altered empiric treatment. Lower airway eosinophilia was identified in 19 (34%) children, BAL microbiology results led to antibiotic changes in 5 (9%) and an unsuspected foreign body was found in another (2%). Strongyloides serology was performed in 38 children, including 12 of the 19 with airway eosinophilia, and was positive in 5 of these 12 children (42%).Conclusion: Contrary to some expert recommendations that FB should only be performed when bronchiectasis is localized, our data suggest that FB with BAL should at least be included in the initial investigations of Indigenous children with non-CF bronchiectasis.

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    KW - indigenous people

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    KW - Klebsiella pneumoniae

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    KW - preschool child

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    KW - Pseudomonas aeruginosa

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