Bronchoscopy

Question

Hello,
Could you tell me, in the context of cystic fibrosis, indications that lead to consider endoscopy of the lungs in children?
Is there an interest for non-expectorating children?
What are the expected benefits? The potential risks?
Is it an increased risk of infection with Pseudomonas aeruginosa?
Thanks in advance
Best regards

Answer

Hello,

The performance of bronchoscopy in children currently remains essentially guided by the clinical symptoms; most often it is made in a particular context which is largely left to the physician's individual assessment who takes care of the child. Too rapid deterioration of respiratory function, persistence of abnormal radiological image, persistence of unusual respiratory symptoms or regression under appropriate antibiotic treatment are, for example, potential indications.

Apart from these indications, endoscopy has no routine interest in children, even among those "not producing secretions". This was demonstrated in an Australian study whose results were published in 2012. This study shows that for pathogen detection as Pseudomonas aeruginosa, the oropharyngeal swab serve as well as samples taken during bronchoscopy and without the risks associated with the gesture and the achievement of general anesthesia (C Wainwright et al. JAMA. 2011). The risk assessment of contamination by PA in these actions has not been evaluated, however, rigorous decontamination measures are taken to minimize as much as possible.

Best regards,
Dr Philippe Reix

16.07.2016