Bronchomalacia in childhood

[Jellybean010101]

Both my 6 and 8 yr old children were just diagnosed with bronchomalacia yesterday after undergoing elective bronchoscopy's. everything I have read says this condition is usually outgrown by 3 yrs or so.  They were currently being treated for asthma both starting at the onset of age 2 after terrible coughing attacks. We decided to do the bronch's because their asthma was just not improving. When they are healthy they are fine. No activity restrictions etc. but when they catch a cols or their allergies act up they get VERY sick for quite a while. Is this normal for them to be this old and still have evidence of bronchomalacia on a bronchoscopy?  Waiting to hear back from the pulmonologist because she did a lavage and sent cultures. So we have to wait for those results.   I saw the pictures and each of their bronchus looked like a teardrop shape. Any help would be much appreciated.

[David Tinkelman, M.D.]

Sorry to learn of the respiratory problems your children have been having.  Reasons for optimism regarding improvement are valid for asthma which is, by and large, a very successfully treatable disease and for uncomplicated (by other anatomical abnormalities) Bronchomalacia the natural history is one of improvement progressing to normality over time.  Medical literature on resolution of wheezing or the Bronchomalacia itself generally suggest that this occurs by age 3 but with individual reports of resolution at an older age.  Also important is the severity of the Bronchomalacia, that can vary from mild to very severe.  What the pulmonologist may have observed may be mild Bronchomalacia in the final stages of resolution.  These are questions you should ask of the pulmonologist.  I assume that she is a Pediatric Pulmonologist and should be able to answer your questions.

The following statements are taken from The Kliegman-Nelson Textbook of Pediatric Medicine and, I believe, support reason for optimism.  

Good luck,

Prognosis
Primary bronchomalacia and tracheomalacia have excellent prognoses, because airflow improves as the child and the airways grow. Patients with primary airway malacia usually take longer to recover from common respiratory infections. Wheezing at rest usually resolves by age 3 yr.
I would note that the resolution of wheezing by age 3 years may not indicate complete resolution of the anatomic changes, that not infrequently takes longer.
Prognosis
• The prognosis is excellent. Most patients outgrow this condition by the time they are aged 3 years; many infants outgrow tracheomalacia before they are aged 1 year.
• If gastroesophageal reflux is present, attention to this speeds healing.
• Tracheomalacia after tracheoesophageal fistula repair may take longer to heal than primary tracheomalacia.
• Tracheomalacia after a compressing lesion lasts longer, depending on the length of time of the compression.

[mommacrews]

Hi, My boy has down syndrome, is 5 years old and are in the same boat. He gets pneumonia every March and has for the last 4 years. This year we have added September and October. We usually stay at the hospital with agressive rounds of breathing treatments and heavy oxygen. My son just had his bronc Nov 29th. I am waiting for labs as well. What to do? Have you heard anything either???