Bronchoscopic abnormalities in children with chronic nonspecific cough

BACKGROUND: Chronic nonspecific cough in children is a common and challenging clinical problem. Flexible bronchoscopy plays a crucial role in identifying underlying etiologies when non-invasive investigations are inconclusive. This study aimed to assess bronchoscopy and related diagnostic findings in children presenting with chronic cough. METHODS: This prospective cross-sectional study included 64 children aged 3 months to 18 years who presented with chronic nonspecific cough lasting more than four weeks. All patients underwent a standardized evaluation that included clinical assessment, laboratory tests, chest X-ray, and high-resolution CT. Pulmonary function testing was performed in children older than five years. Flexible bronchoscopy was conducted, and bronchoalveolar lavage samples were examined for cytological and microbiological analysis. RESULTS: This prospective study included 64 children (32 males) with a median age of 8 months (IQR 36-84) with chronic cough, classified as dry (n = 38), wet (n = 21), or barking (n = 5) cough. Bronchoscopy revealed abnormalities in 87.5% of cases, most commonly purulent secretions and congenital airway anomalies. BAL showed neutrophilia in 95.3%, and cultures were positive in 20.3%, mainly for Haemophilus influenzae and Streptococcus pneumoniae. For predicting PBB, the combined multivariable model demonstrated good discriminative ability (AUC = 0.809, P = 0.004). Increasing age (OR = 1.038, P = 0.024) and tobacco smoke exposure (OR = 4.15, P = 0.04) were significant independent predictors. For congenital airway anomalies, the combined model demonstrated excellent predictive performance (AUC = 0.912, P < 0.001), outperforming individual clinical variables. CONCLUSION: Flexible bronchoscopy demonstrated a high diagnostic yield in children with chronic cough that remained unexplained following comprehensive noninvasive evaluation. However, a definitive assessment of its clinical utility requires direct comparison with other diagnostic modalities, which is addressed in the subsequent analysis.