The diagnosis, investigation and particularly management of bronchiectasis has been largely empirical and the subject of relatively few controlled clinical trials. There are no clear guidelines, although an Australian position statement has been published concerning bronchiectasis in children. The purposes of these guidelines were therefore threefold: (1) to identify relevant studies in non-cystic fibrosis (CF) bronchiectasis; (2) to provide guidelines on management based on published studies where possible or a consensus view; and (3) to identify gaps in our knowledge and identify areas for future study.

https://thorax.bmj.com/content/thoraxjnl/65/Suppl_1/i1.full.pdf

British Thoracic Society guideline for non-CF bronchiectasis.

Bronchoscopy for evaluation of foreign body aspiration in children.

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. We reviewed a total of 174 children with foreign body aspiration (FBA). Clinical, radiological, and bronchoscopic findings of these patients were evaluated according to the nature of foreign body and elapsed time from aspiration to diagnosis. Significant differences were noted between patients with organic and inorganic FBA in terms of clinical and radiological findings. Cough, recurrent pneumonia, and fever were the most common presenting symptoms in patients with delayed diagnosis. Long-term follow-up was available for 110 patients for a mean duration of 37.8 +/- 23.7 months (range, 1-88 months). We evaluated the course of recovery after bronchoscopic removal. Organic FBA was of comparable duration as for inorganic FBA, and prolonged follow-up was associated with increased risk of persistent symptoms and bronchiectasis (P < 0.001). The risk of long-term complications increased with increasing elapsed time from aspiration to diagnosis; complications were as high as 60% in children who were diagnosed 30 days after FBA (P = 0.0035). Bronchiectasis was a major complication, found in 25% of patients whose diagnosis was delayed by more than 30 days (P = 0.0001). Three patients with bronchiectasis underwent lobectomy. Patients with persistent asthma-like symptoms such as cough and wheezing required treatment with inhaled corticosteroids and bronchodilators. The positive response to this treatment was thought to be a confirmation of the development of transient bronchial hyperresponsiveness induced by foreign bodies. We conclude that timely diagnosis and appropriate treatment of FBA is important to prevent long-term complications in affected children.

Foreign body aspiration: what is the outcome?

Foreign body aspiration is a worldwide health problem which often results in life threatening complications. More than two thirds of foreign body aspirations occur among children younger than 3 years. Organic materials such as nuts, seeds, and bones are most commonly aspirated. There is a wide range of clinical presentation, and often there is not a reliable witness to supply the clinical history, especially in children. Maintaining a high index of suspicion is therefore necessary for the diagnosis. None of the imaging methods employed in such cases are diagnostic, and bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during diagnostic examination with a fibreoptic bronchoscope under local anaesthesia, which may help to avoid any further invasive procedures with more complications. When diagnosis is delayed, complications of a retained foreign body such as unresolving pneumonia, lung abscess, recurrent haemoptysis, and bronchiectasis may necessitate a surgical resection. However, some of the late complications may resolve completely after the retrieval of the foreign body, therefore, a preoperative flexible bronchoscopy should always be considered in suitable cases.

https://pmj.bmj.com/content/postgradmedj/78/921/399.full.pdf

Foreign body aspiration: clinical utility of flexible bronchoscopy

Adult airway foreign body removal. What's new?

Tracheobronchial foreign bodies: presentation and management in children and adults.

Dept of Pulmonary Medicine, ENT, Antwerp University Hospital, Belgium; Dept of Respiratory Medicine, University Hospital Maastricht, The Netherlands; Dept of Home Care, Medigaz-Air Products, Brussels, Belgium; Dept of Internal Medicine, Hôpitaux Chirec Site Edith Cavell, Brussels, Belgium; Dept of Pulmonary Medicine, CHR de la Citadelle, Liège, Belgium; Dept of Pulmonary Medicine, Cliniques Universitaires St-Luc, Brussels, Belgium

Treatment of mild obstructive sleep apnea syndrome (OSAS) with excessive daytime sleepiness: a randomised controlled single blind trial of CPAP versus nasal strips

https://doi.org/10.5935/1984-0063.20220057

Farhad Baharloo

Papers

Tracheobronchial foreign bodies: presentation and management in children and adults.

Treatment of mild obstructive sleep apnea syndrome (OSAS) with excessive daytime sleepiness: a randomised controlled single blind trial of CPAP versus nasal strips

Validation of mandibular movements’ analysis to measure sleep in adults with sleep complaints by comparison with actigraphy and polysomnography