Atopy and central airway stenosis in infants with persistent wheezing

Objective: This study was done to analyze the frequency, type and location of central airway stenosis in young infants with persistent wheezing unresponsive to bronchodilators and its relationship with atopy. Methods: Over a two year period (1992-1994) bronchoscopic procedures were performed in children less than 18 months old, hospitalized in the Children's University Hospitals of Bochum and Koln with persistent wheezing. Sex, age, atopy, duration of wheezing, previous therapy and bronchoscopic findings were analyzed. Infants with foreign body aspiration, cystic fibrosis or chronic neonatal lung disease were excluded. Statistical analysis was performed using chi square test. Results: Bronchoscopy was executed in 43 infants and revealed stenosis of the main bronchus in 16, tracheomalacia in 12, tracheal compression in 4 and bronchial anomaly in 2 cases. Inflammatory changes only were found in 9 patients. The male/female sex ratio was 3 : 1. The mean duration of obstructive airway symptoms was 5 months. More than one third of the cases received topical or systemic steroids. Atopy was present in 17 patients. Central airway stenosis showed a similar frequency in atopic and non atopic infants. Conclusions: Bronchoscopy should be considered in all infants with persistent wheezing, including those with proven atopic disposition, to facilitate early recognition and treatment of critical central airway stenoses.