Advances in pediatric flexible bronchoscopy

Flexible bronchoscopy (FB) is a highly versatile and effective diagnostic and therapeutic tool with a pivotal position in respiratory medicine.Indeed, the flexible bronchoscope, with its capability to visualize both the upper and lower airways, is indispensable for managing neonates, infants, and children with diverse respiratory diseases [1].Despite the use of guidelines on pediatric flexible bronchoscopy (PFB) from the European Respiratory Society [2], the American Thoracic Society [3] and a Chinese guideline released in 2009 [4] and updated in 2018 [5], considerable variation exists.This is related to the provision of facilities, accessibility of equipment, and implementation.Standards remain to be fully unified.With the ongoing development of PFB technology, contemporary anesthetic techniques and a growing acknowledgment of the benefits provided by PFB, there has been increased application of this technique in children over the past 4-5 years [6].Nevertheless, several important points require careful consideration.These are: (1) diverse indications for PFB; (2) preparatory steps prior to personalized bronchoscopy, anesthesia, and bronchoalveolar lavage (BAL) in accordance with contemporary practice; (3) striking a balance between safety and therapeutic effectiveness; and (4) principal challenges for future development.In this editorial, we discuss these important points with an emphasis on advances, improving understanding, implementation, and advocacy for PFB.