Bronchography

Abstract: Asthma is a chronic disease whose definition is difficult, possibly because it is heterogeneous and multifactorial. In 1959 the Ciba Symposium proposed that \"asthma refers to the condition of subjects with widespread narrowing of the bronchial airways, which changes in severity over short periods of time, either spontaneously or under treatment and is not due to cardiovascular disease\" (1). In 1962 the American Thoracic Society defined asthma, emphysema and chronic bronchitis in basically similar terms, but this statement included increased airway responsiveness in its definition of asthma and noted that some asthmatics, particularly those who have had asthma for many years, may have persistent airfiow obstruction (2). These definitions are based on clinical and functional terms and make the characterization of a substantial number of patients difficult since for the vast majority of physicians asthma is synonymous with a reversible obstruction. However, many patients with asthma have a poor reversibility whereas others with chronic bronchitis have some component of airways reversibility (3).

Abstract: 1. 1. Congenital stenosis of the trachea is a relatively uncommon anomaly yet one which should be recognized since in many instances the lesion is susceptible to correction. 2. 2. The presence of stridor, dyspnea and cyanosis in a newborn infant or small child should suggest the possibility of tracheal stenosis. 3. 3. Definitive diagnosis can be established by lateral roentgenograms of the chest, bronchoscopy and/or bronchography. 4. 4. Complete correction of this anomaly should be possible in many instances by excision of the stenotic area and reanastomosis of the trachea. 5. 5. A case of segmental stenosis of the trachea corrected in this manner is described. To our knowledge, this case is the first in which successful operative correction of such a defect has been accomplished.

Abstract: Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.