Primary bronchomalacia in infants and children

Objective: To determine the natural history of primary bronchomalacia in infants and children. Study design: Retrospective chart review and follow-up telephone questionnaire of 17 patients with bronchoscopically confirmed primary bronchomalacia. Results: All patients had initial symptoms within the first 6 months of life, and all patients were thought by their primary care physicians to have reactive airways disease. In no patient was the diagnosis of bronchomalacia considered before referral to our center. All patients had a harsh, monophonic wheeze loudest over the central airway and intermittently present between illnesses. All 17 patients had bronchomalacia of the left main-stem bronchus; two had mild tracheomalacia associated with the bronchomalacia; and one had bilateral bronchomalacia. One patient had associated laryngomalacia. Twenty-five percent of our patients had reactive airway disease in addition to bronchomalacia. With growth, all patients have shown a gradual improvement and a cessation of daily symptoms. All three patients older than the age of 5 years report limitation of vigorous exercise. Conclusions: Bronchomalacia should be considered in the differential diagnosis of the persistently wheezing infant and should be evaluated appropriately. More severe forms of bronchomalacia appear to predispose patients to exercise limitation later in life, which suggests that the lesion does not completely resolve with growth.