THE ROLE OF BRONCHOSCOPY IN WHEEZING PRESCHOOL CHILDREN

Lower airway tract illnesses with wheeze are common in the preschool child and occur in approximately one-third of all children. Most children with preschool wheeze do not need further investigation, but referral is needed in the following cases: if the child does not respond to treatment, if the diagnosis is in doubt, if there are other comorbid conditions present and if the wheezing is audible without a stethoscope. When the wheeze is harsh, low pitched and monophonic, large airway obstruction must be considered. The role of bronchoscopy in pre-school wheezing includes evaluating the airways for any structural and anatomical abnormalities. Thirty per cent of children investigated by airway survey will benefit from bronchoscopy. In 40-60% of children with recurrent or persistent wheeze an organism is isolated from the bronchoalveolar lavage specimen. The reported complication rate in these studies was very low. A selective group of preschool wheezing children who are not responding to treatment have symptoms of large airway obstruction; symptoms suggestive of gastro-oesophageal reflux or unilateral chest signs may benefit from flexible bronchoscopy to diagnose the cause of their wheezing.