CLINICAL UTILITY OF FLEXIBLE BRONCHOSCOPY AND BRONCHOALVEOLAR LAVAGE IN YOUNG-CHILDREN WITH RECURRENT WHEEZING

Objective: The objective of this study was to determine in young child ren with recurrent wheezing poorly responsive to bronchodilator therap y whether flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) provide clinically useful information, whether age-specific difference s are present in bronchoscopic and BAL fluid (BALF) findings, and whet her differential cellular analysis of BALF is useful in suggesting an infectious or inflammatory process. Design: This was are retrospective case series with descriptive and analytical components. The study pop ulation included children referred to a large tertiary care children's hospital subspecialty service for further evaluation of recurrent whe ezing. Clinical and demographic data and findings of FB and BALF studi es were collected from chart review For purposes of data analysis pati ents were divided into 0- to 6-, 7- to 12-, and 13- to 18-month age gr oups. Results: Thirty otherwise healthy children, 0 to 18 months of ag e with recurrent wheezing, who had undergone FB were identified; and 2 8 were found to have positive diagnostic findings. Airway abnormalitie s were found in 17 (57%) and tended to be more common in the 0- to 6-m onth age group. In the 27 who also had BAL performed, 3 (11%) had a po sitive bacterial culture, 9 (33%) a positive viral culture, and 5 (19% ) an elevated lipid-laden macrophage index suggesting aspiration. Diff erential cellular analysis was abnormal in 11 (41%), a finding that wa s significantly associated with a positive bacterial culture, a positi ve viral culture, or an elevated lipid-laden macrophage index. Conclus ions: In this population of young children with recurrent wheezing poo rly responsive to bronchodilator therapy, FB and BAL yielded useful di agnostic findings in most children studied. In addition, in the presen ce of an infectious or inflammatory process, differential cellular ana lysis of BALF revealed an increased percentage of neutrophils.