Asthma: the great imitator in foreign body aspiration?

OBJECTIVE: To determine the prevalence of underlying lower airway inflammatory conditions in children who underwent rigid bronchoscopy (RB) for a suspected foreign body aspiration (FBA) in the tracheobronchial tree and to identify the characteristics of patients who could benefit from a trial of antiasthma treatment prior to undergoing a diagnostic bronchoscopy.

DESIGN: Retrospective chart review.

SETTING: Children with suspected FBA in the tracheobronchial tree who underwent RB at the Montreal Children's Hospital (2001-2009).

METHODS: Patient characteristics such as clinical, radiologic, and bronchoscopic findings on presentation, as well as prior use of inhaled bronchodilators or corticosteroids, were analyzed. A p value < .05 was considered significant.

MAIN OUTCOME MEASURES: Use of inhaled bronchodilators or corticosteroids, signs, symptoms, and radiologic and bronchoscopic findings on presentation.

RESULTS: Fifty-five children underwent an RB for suspected FBA. Foreign bodies were found in 36 subjects. Asthmatics were significantly more likely to have a negative bronchoscopy than nonasthmatics (80.0% vs 30.0%, p < .05). Otherwise, clinical and radiologic findings were not significantly different in these two groups. The median time between the suspected choking event and the first otolaryngology evaluation was 14 days in asthmatics (range 5 hours-90 days), whereas it was 16 hours in nonasthmatics (range 0.5 hours-120 days).

CONCLUSION: A conservative approach cannot be justified in suspected asthmatic children with possible FBA, in whom the indications for diagnostic bronchoscopy must be tailored to each patient to ensure a timely diagnosis.