Management of plastic bronchitis withTopical Tissue-type Plasminogen Activator instillation in children

<bold>Introduction:</bold> Plastic bronchitis (PB) is a rare condition in which branching casts are formed in the airways. We aimed to evaluate the effectiveness of Topical Tissue-type Plasminogen Activator (tPA) instillation in children with PB. <bold>Methods:</bold> We performed a retrospective descriptive study including children treated for PB with topical tPA instillation in our pulmonology department between January 2014 and December 2023. <bold>Results:</bold> Among the nine children diagnosed with PB, six underwent tPA instillation (four boys and two girls). The mean age was 9 years. Patients’ history consisted of bronchiectasis (n=3) and lower respiratory tract infections (n=6). The clinical presentation consisted of fever (n=4), cough (n=3), dyspnea (n=2) and chest pain (n=1). Chest radiography showed left atelectasis in 4 cases. Flexible bronchoscopy revealed total obstruction of the lingula (n=2) and the left basal pyramid (n=3) in most cases. Two children underwent bronchoalveolar washing as an initial treatment. PB recurred after 7 months in one case and 30 months in the second case. All children underwent topical tPA instilation during flexible bronchoscopy under general anaesthesia followed by cast aspiration with no complication. The long-term evolution was marked by the recurrence of PB in one case in a year, and the recurrence of a lower respiratory infection in one case also in a year. The remaining four cases showed no recurrence of PB or respiratory infections after a mean follow-up period of four years [4-8 years]. <bold>Conclusion:</bold> Direct tPA administration into the airways appears to be safe and effective and should be considered early in the course of PB in children to prevent complications.