Improving the knowledge and utility of flexible bronchoscopy in children

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FB is primarily used in children for diagnostic purposes and sometimes is also therapeutic. It involves viewing airways with a flexible instrument, and obtaining lower airway specimens. FB is commonly used in paediatric respiratory centres around the world to help in diagnosis and to help guide management in patients with respiratory complaints like chronic cough, recurrent croup and recurrent wheeze. Publications on indications, contraindications and complications of FB are based on expert opinion and retrospective studies. Indeed, two international thoracic societies (American Thoracic Society and European Respiratory Society) highlighted the paucity of prospective studies and absence of any RCTs. This is a critical gap, as FBs are undertaken using general anaesthesia. There are risks associated with general anaesthesia in addition to those from FB itself (e.g. hypoxia, nausea, vomiting, headaches, confusion and unscheduled hospitalisation). There are also cost implications to the health system and the family. Thus, it is not surprising that different centres have varying approaches resulting in vast differences in the number of FBs undertaken. At Queensland Children’s Hospital, Brisbane, ~550 FBs/year are undertaken but other Australian paediatric centres carry out less than half of this number. Thus, a RCT is required to define the efficacy and benefits to address this gap. Our study’s goal is to examine the impact of FB on quality of life (patient reported outcome) and change in management in children under the rigour of an RCT with the hypothesis that paediatric FB leads to improvement in quality of life and to change in managment. Ultimately, this will clarify the utility of FB in children and will improve clinical outcomes for children.