Clinical features and treatment issues in pediatric tracheobronchomalacia

Abstract Background The purpose of this study was to outline the variable clinical presentations of tracheobronchomalacia in children, as well as the treatment options available, which may include either conservative or surgical approaches. Methods This is a retrospective descriptive study involving a review of medical charts for patients admitted to the Pediatric Pulmonology Unit diagnosed with airway malacia from January 2021 to December 2024. Patients were further classified according to the level of airway malacia into tracheomalacia (TM), bronchomalacia (BM), and tracheobronchomalacia (TBM). Results Sixty-eight children with airway malacia were included in the study. Among them, thirty-eight were male. The median age of the participants was 28.0 months, with the median age at which symptoms first appeared being 14.5 months. The most common indications for flexible bronchoscopy were persistent radiological findings, observed in 36.8% of the cases, followed by recurrent chest infections at 22.1%. Other notable presentations included recurrent or persistent wheezing (17.6%), recurrent or persistent stridor (13.2%), and both wet cough and barking cough, each occurring in 11.8% of the patients. Additionally, difficult extubation was reported in 8.8% of the cases. Surgical treatment was performed in 14/68 (20.6 %) of children, with no significant difference between TM, BM, and TBM in the rate of interventions. Conclusions Early diagnosis of airway malacia, along with recognizing its underlying causes and associated comorbid conditions, will lead to better treatment and prevention of complications.