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Association of childhood tracheomalacia with bronchiectasis: a case–control study
  1. Rahul Thomas1,2,
  2. Anne Chang1,2,3,
  3. Ian Brent Masters1,2,
  4. Keith Grimwood4,5,6,
  5. Julie Marchant1,2,
  6. Stephanie Yerkovich1,3,
  7. Mark Chatfield7,
  8. Christopher O'Brien8,
  9. Vikas Goyal1,2,6
  1. 1Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  2. 2Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
  3. 3Child Health Division, Menzies School of Health Research, Darwin, Australia's Northern Territory, Australia
  4. 4School of Medicine and Menzies Health Institute Queensland, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
  5. 5Departments of Infectious Diseases, Gold Coast University Hospital, Southport, Queensland, Australia
  6. 6Department of Paediatrics, Gold Coast Health, Southport, Queensland, Australia
  7. 7Faculty of Medicine, The University of Queensland Faculty of Health Sciences, Herston, Queensland, Australia
  8. 8Department of Radiology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
  1. Correspondence to Dr Rahul Thomas, Respiratory and Sleep Department, Queensland Children's Hospital, South Brisbane 4101, Queensland, Australia; rahul.thomas{at}


Objective Children with tracheomalacia can develop chronic lower airway infection and neutrophilic inflammation. It is plausible children with tracheomalacia are at increased risk of developing bronchiectasis. We hypothesised that compared with controls, tracheomalacia in children is associated with bronchiectasis.

Design Single-centre, case–control study.

Setting and patients 45 children with chest high-resolution CT (c-HRCT) confirmed bronchiectasis (cases) and enrolled in the Australian Bronchiectasis Registry were selected randomly from Queensland, and 90 unmatched children without chronic respiratory symptoms or radiographic evidence of bronchiectasis (disease controls). Cases and controls had flexible bronchoscopy performed for clinical reasons within 4 weeks of their c-HRCT.

Interventions The bronchoscopy videos were reviewed in a blinded manner for: (a) any tracheomalacia (any shape deformity of the trachea at end-expiration) and (b) tracheomalacia defined by the European Respiratory Society (ERS) statement (>50% expiratory reduction in the cross-sectional luminal area).

Main outcome measures and results Cases were younger (median age=2.6 years, IQR 1.5–4.1) than controls (7.8 years, IQR 3.4–12.8), but well-balanced for sex (56% and 52% male, respectively). Using multivariable analysis (adjusted for age), the presence of any tracheomalacia was significantly associated with bronchiectasis (adjusted OR (ORadj)=13.2, 95% CI 3.2 to 55), while that for ERS-defined tracheomalacia further increased this risk (ORadj=24.4, 95% CI 3.4 to infinity).

Conclusion Bronchoscopic-defined tracheomalacia is associated with childhood bronchiectasis. While causality cannot be inferred, children with tracheomalacia should be monitored for chronic (>4 weeks) wet cough, the most common symptom of bronchiectasis, which if present should be treated and then investigated if the cough persists or is recurrent.

  • paediatrics
  • respiratory medicine

Data availability statement

Data are available upon reasonable request. Data available from corresponding author of this manuscript.

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Data availability statement

Data are available upon reasonable request. Data available from corresponding author of this manuscript.

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  • Contributors AC, IBM, KG, JM and VG contributed to the study design and concept. RT contributed to data extraction and collection while IBM and AC contributed to flexible bronchoscopy review part of the data collection process. RT, VG, SY and MC contributed to data analysis and had access to all data. RT contributed to drafting of the manuscript with supervision and revisions contributed to by AC, KG, IBM and JM. CO’B contributed to the manuscript draft in regard to the methods for HRCT of the chest. RT is the guarantor of the paper (taking responsibility for the integrity of the work as a whole, from inception to published article).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RT has a postgraduate scholarship (for PhD) from National Health and Medical Research Council, Australia (APP1190908) and PhD top-up scholarship from Children’s Health Foundation, Queensland (RPC00072) during the conduct of the study. AC has received grants from National Health and Medical Research Council, Australia (NHMRC) and other fees to the institution from work relating to being an IDMC member of an unlicensed vaccine (GSK) and an advisory member of study design for unlicensed molecule for chronic cough (Merck) outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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