الفهرس 
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Abstract
Noisy breathing is a very common complaint among children, invariably indicating some degree of airway obstruction. It may carry risk for life threatening problem. It is a loose term includes stridor, wheezing and other “abnormal” breathing sounds such as grunting, snuffling, rattling, and snoring. However, persistent or atypical noisy breathing should rise the suspension of different diagnosis and re-evaluation of the patient should occur.
The flexible bronchoscope has become one of the most widely used diagnostic and therapeutic tool by pediatric pulmonologists. In addition to allowing direct visualization of the respiratory passages and the assessment of airway dynamics (e.g., malacia), it also, allows for endobronchial treatment of airway lesions (e.g., AFB removal, re-canalize obstructed bronchus by mucous plugs) and collection of samples by BAL for histopathological, microbiological and cytological investigations.
Bronchoscope is an invasive procedure that requires anesthesia in children. It carries some risk of complications such as desaturation, airway trauma, and laryngeal spasm. Several gaps in our knowledge needed to be passed, especially regarding ways to improve diagnostic capabilities and minimize complications.
In this study, we aimed to evaluate the utility of pediatric bronchoscopy as a safe diagnostic tool for persistent or atypical noisy breathing children to prevent unnecessary drug administration, laboratory investigation and hospital admissions causing an increase in health care cost. Also to justify the possible complications and methods of management.
The study included one hundred (100) patients with persistent noisy breathing for more than 21 days and aged from 1 month to l6 years of both sexes, recruited from the Pulmonology units and outpatient clinics at Assiut and Sohag University Hospital, Egypt. This study is a prospective study using fixable bronchoscopy at a tertiary care medical center (Sohag University Hospital).
The pathogenesis of noisy breathing summarized based on clinical features, radiological finding, results of bronchoscopy inspection. Patients known to be asthmatic or hyperactive airway, with history of foreign body aspiration, syndromatic disease and children with diagnosed chronic chest disease as bronchiectasis, cystic fibrosis, chest tuberculosis, BPD… etc.., were excluded.
Generally, we evaluate how bronchoscopy contributed to the patients’ diagnosis, what were the complications and limits in our center and how we could deal with them.
Written informed consent was taken after explaining the procedure pros and cons.
In our study, we found 67% of patients were males. Median age was 16 months at the presentation and median duration of symptoms was 2 months. Bronchoscope revealed that 37% patients had malacia disorders, 22% had airways inflammation, 20% had neglected foreign body aspiration, 6% had vocal cord dysfunction, 6% had subglottic stenosis, 4% had tracheal stenosis, 1% had subglottic heamangioma and in 4% of cases no abnormalities could be detected. No major complications were detected however, minor complications were detected in 20% of cases. The most common procedure complications were desaturation with incidence 10%, followed by exaggerated cough reflex in 5%, Laryngeal spasmin 3% and Bronchospasm in 2% of cases.
In Conclusion, Flexible bronchoscopy provided rapid and definitive diagnosis for our patients with persistent wheezing or/and stridor without any major complications. Early bronchoscopic evaluation can reduce costs by providing rapid and accurate diagnosis and preventing unnecessary investigations and drug administration. Flexible bronchoscopy is a safe procedure and should be considered in the evaluation of children with persistent or atypical noisy breathing.