PRIMARY TRACHEOBRONCHOMALACIA AND INFANTI LE ASTHMA

Primary tracheobronchomalacia (TBM) is a fairly common disease of youn g children secondary to insufficient maturation of tracheobronchial ca rtilage. This diagnosis must be considered in a child with cavernous t racheal cough and chronic ''wheezing'' of delayed onset after birth (e specially following a viral infection) and refractory to antiasthmatic treatments. Physical signs indicative of an anatomical lesion of the upper airways, especially distension and absence of signs of retractio n are suggestive of the diagnosis. The key examination for the diagnos is is flexible bronchial fibroscopy under local anaesthesia which show s excessive closure of the tracheal and/or bronchial lumen on forced e xpiration or while coughing. Secondary TBM can be excluded on the clin ical history (prematurity, neonatal ventilation) a context of multiple malformations (oesophageal atresia, xyphoid funnel, facial dysmorphia ) and by systematic barium swallow (for aortic arch abnormalities). Re spiratory physiotherapy is the treatment of choice. Antibiotic therapy and bronchodilators (preferably synthetic anticholinergics) can be us eful. Very exceptionnaly thoracic surgery (such as tracheoplexy or end obronchial prosthesis) may be indicated, especially in secondary and/o r assisted ventilation dependent TBM. The natural course of TBM toward s cure is due to growth of the tracheobronchial tree at the age of 3 y ears.