الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 261 |  |  |
| | | from | 261 | | |
Abstract
Chronic cough in children is a common reason for healthcare visits and affects between 5% and 10% of children in the general population, as estimated based on parental questionnaires. The definition of chronic cough varies among different guidelines. It is defined as a persistent and unremitting cough lasting more than four weeks in the 2020 CHEST consensus statement. The British Thoracic Society guidelines label chronic cough in children as one that lasts beyond eight weeks, while acknowledging the existence of a prolonged subacute cough that lasts between four and eight weeks. Wheezing in children is a common problem encountered by family physicians. Approximately 25 to 30 percent of infants will have at least one wheezing episode, and nearly one half of children have a history of wheezing by six years of age. The most common causes of wheezing in children include asthma, allergies, infections, gastroesophageal reflux disease, and obstructive sleep apnea. Children with continuous wheezing for at least 1 month or minimum three episodes of wheezing in 2 months are defined as persistent wheezy children. This study aimed to evaluate the diagnostic role of Flexible Fiberoptic Bronchoscope in evaluation of Children with chronic cough and / or persistent wheezing. It was a prospective study included a total of 64 infants and children attended the pediatric chest Clinics or emergency room in Pediatric Departments Tanta &Ain-Shams Universities Hospitals or admitted in their pulmonology units during the study period from January 2021 to January 2023. As regards to demographic data of our cases, There were 25 cases with chronic cough and 39 cases with chronic cough and persistent wheeze. There were 32 males and 32 females. As regards to age , 6 cases were below 1 year , 31 cases were between 1-5 years and 27 cases were more than 5 years. As regards to weight of our cases, 51 cases were normal and 3 cases were below 3rd percentile. As regards to height, 51 cases were normal and 3 cases were below 3rd percentile. As regards to clinical manifestations, the most common presenting sign was respiratory distress (24%) of cases with chronic cough and (20.4%) of cases with chronic cough and persistent wheeze. As regards x ray findings , X ray was normal in 90 % of cases of chronic cough and 86.7 % of cases of chronic cough and persistent wheeze. There were other findings as increased bronchovascular markings, lung collapse and consolidation. As regards to CT chest findings, It was normal in 64% of cases of chronic cough and 59.5% of cases of chronic cough and persistent wheeze. the most common finding was collapse, 16% of cases of chronic cough and 18.9 % of cases of chronic cough and persistent wheeze . There were other findings as consolidation , ground glass opacity and bronchiectasis . As regards to pulmonary function tests , It was normal in 69.2% of cases of chronic cough and 85.7% of cases of chronic cough and persistent wheeze. Obstructive pattern was found in 7.7 % of cases of chronic cough and 14.3% of cases of chronic cough and persistent wheeze. Restrictive pattern was found in 23.1 % of cases of chronic cough and not found in any case of chronic cough and persistent wheeze. As regards to CBC findings , 64% of cases of chronic cough and 46.2% of cases of chronic cough and persistent wheeze presented with anemia. 20% of cases of chronic cough and 28.2% of cases of chronic cough and persistent wheeze presented with leucopenia. 52% of cases of chronic cough and 35.9 % of cases of chronic cough and persistent wheeze presented with leukocytosis. As regards to CRP findings , Negative CRP was found in 60 cases and positive CRP was found in 4 cases. As regards to Bronchoscopic Findings in Cases with chronic Cough, mucopurulent secretions were the most common bronchoscopic finding in children with chronic cough (64% of cases) . there were other findings as congenital airway anomalies (16% of cases), mass occluding bronchus (4% of cases), and normal airway was detected in 16% of cases. As regards to Bronchoscopic findings in cases with chronic cough and Persistent Wheeze , congenital airway anomaly was the most common bronchoscopic finding in children with chronic cough and persistent wheeze (41% of cases) . there were other findings as Tracheal or bronchial compression (15.6 % of cases ), FB impaction (12.8 % of cases) , secretions (7.8% of cases), mass occluding bronchus (10.4% of cases) and normal airway was detected in 12.8 % of cases. laryngotracheomalacia (10.2 % of cases) and left mainstem bronchomalacia (10.2 % of cases) were the most common congenital airway anomaly detected in bronchoscopic examination in children with chronic cough and persistent wheeze. As regards to Bronchoalveolar Lavage Findings in our cases, As regards to culture , no growth of organisms was detected in 89.7% of cases . the most common isolated organisms were Hemophilus influenza (5.1% of cases) and streptococcus pneumonae ( 5.1% of cases). As regards to cytological examination , Neutrophilia was detected in 94.9 % of cases and lymphocytosis was detected in 5.1% of cases. As regards to gene xpert for TB, it was positive in only in one case with chronic cough. As regards to Final Diagnosis of Cases with chronic Cough, protracted bacterial bronchitis was the most common etiology of chronic cough (52% of cases). There were other etiologies as congenital airway disease (16% of case), mucous plug (8%) hypersensitivy pneumonitis (4% of cases) and TB ( 4% of cases). The cause was still unknown in 16% cases. As regards to Final Diagnosis of Cases with chronic Cough and Persistent Wheeze, congenital airway disease was the most common etiology of chronic cough and persistent wheeze (41% of cases). There were other etiologies as FB aspiration (12.8 % of cases ) , Bronchogenic cyst (7.7% of cases) ,Vascular ring (7.7% of cases) , Pulmonary alveolar proteinosis (2.6% of cases), Protracted bacterial bronchitis (2.6% of cases), mucous plug (2.6% of cases) , hypersensitivity pneumonitis(2.6% of cases), Inflammatory myofibroblastic tumor (2.6% of cases) , Plastic bronchitis (2.6% of cases) and intraluminal leiomyoma (2.6% of cases) . The cause was still unknown in 12.6% cases. As regards to post bronchoscopy complications, there were no significant complications followed bronchoscopy procedure. Transient desaturation was found in 10.9% of cases , there were other complication as laryngospasm ( 6.3% of cases), transient fever (7.8% of cases) and transient tachycardia (4.7% of cases). No complications were detected in 70.3 % of cases.