Details about Quantified Tracheobronchomalacia Disorders and Their Clinical Profiles in Children

childrenA total of 116 children (77 male) including 81 with malacia (57 male) were enrolled into the study. The median age of the entire study group was 2.1 years (minimum age, 0.2 years; maximum age, 17.3 years), while that of the malacia group (n = 81) was 1.9 years (minimum age, 0.2 years; maximum age, 12.4 years) and that of the control group (n = 35) was 3.8 years (minimum age, 0.2 years; maximum age, 17.3 years; p = 0.01). Although the control group was significantly older, these differences were lost when the group was stratified into age groups (p = 0.09). There were no gender differences between the groups (p = 0.17). The age and gender distribution demographics of the children (< 2 years, 2 to 3 years, and > 4 years) are presented in Table 1.

Description of Malacia Group

Patients in the malacia subgroups TM, TBM, and BM had similar gender, age, age distributions, and body mass index characteristics. There were no significant differences among any of the subgroups, as shown in Table 2. The median (min, max) areas of the tracheomalacia lesions in the TBM group were significantly smaller than isolated TM at 20.8 mm2 (minimum area, 6.2 mm2; maximum area, 39.8 mm2) and 18.8 mm2 (minimum area, 5.1 mm2; maximum area, 27.5 mm2; p = 0.05), respectively, while the BM sites were larger in the TBM groups than in the isolated BM sites at 14.2 mm2 (minimum area, 0 mm2; maximum area, 32.7 mm2) and 8.6 mm2 (minimum area, 3.9 mm2; maximum area, 22.6 mm2; p = 0.04), respectively. The cricoid sizes were not significantly different (p = 0.30), but the TM-ACR and BM-ACR tertiles were significantly smaller in the isolated TM site (p = 0.005) and BM site (p = 0.05) compared with those in the TBM site. Treat your diseases with My Canadian Pharmacy.


Comparison of Illness Profiles

Complete illness frequency data for 1 year of follow-up was available in 96 of 116 patients (82.8%). The ones with incomplete data (n = 20) were from the malacia group. Comparison of these 20 children with those with complete data showed no significant differences in the distributions of age and gender classifications. The illness profiles of malacia patients and control subjects were compared by the following two main criteria: (1) ARI frequency; and (2) severity of ARIs and cough scores. The median frequency of ARIs in 12 months was significantly greater in the malacia group than in the control group, and the relative risk adjusted (RRadj) for age and gender of an ARI in the malacia group was 2.1(95% confidence interval [CI], 1.3 to 3.4) compared to the control group (Table 3).

Illness Severity

Illness Severity

Complete CARIFS data were available for the first illness in 54 of the 116 children enrolled in the study. In the 62 patients with missing data, those with malacia (n = 39; 63%) were significantly more likely not to fill in the CARIFS (p = 0.002) than those in the control group (n = 21). Children with malacia who did not provide any CARIFS data had significantly lower illness frequency than those who provided both CARIFS and ARI illness frequency data (p < 0.001). CARIFS data were used in the following two ways: (1) severity of the initial phase of illness defined by CARIFS-d1 score; and (2) recovery from illness defined by RQCS.

The severity of the initial phases of ARIs was greater in the malacia group (Table 4). The median (minimum, maximum) CARIFS-d1 scores for the malacia group were significantly higher than those in the control group, with the age and gender RRadj CARIFS-d1 score being 66% higher (p = 0.03) than that in the control group, as shown in Table 4. The RQCS, which reflects illness recovery, was not significantly different between the groups. However, the malacia group had a 25% slower recovery rate at day 14 than the control group (Table 4).

Complete cough diary score data for the first illness was available in 42 of the 116 patients. In the 74 patients in whom there were missing data, there were no significant age or gender differences, but again, as with the CARIFS, the malacia group (n = 63) was significantly overrepresented at 85% (p = 0.03).

Significant coughing and cough disrupting daily activities were both more likely in the malacia group than in the control group (Table 5). In the malacia group, the RRadj of having a median cough score of a 4 was 7.2 (95% CI, 1.91 to 27.2) compared to control subjects. There was a highly significant correlation (r = 0.54) between the cough diary score and the average CARIFS score (p < 0.001), indicating that the sicker children had more troublesome coughing.

Relationship of Illness Profiles With Site and Severity of Malacia

The median ARI frequency rates for children with TM, TBM, and BM were 3.0 (minimum, 0; maximum, 9), 2.0 (minimum, 0; maximum, 7) and 3.0 (minimum, 0; maximum, 6), respectively with no significant difference (p = 0.25) among the groups. Similarly, all forms of the CARIFS and cough diary scores were not significantly different for any of the subgroups of malacia patients or their ACR tertiles (data not shown; p value range, 0.25 to 0.40). These data indicate that neither malacia site nor severity of lesion exerted any dose effects on illness profiles in terms of illness severity.

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Table 1—Age Group Distribution and Number of Male Malacia Patients and Control Subjects, and the Overall Group

AgeGroups Malacia Group (n = 81) Control Group (n = 35) Overall (n = 116) p Value
< 2 yr 41 (50.6) 12 (34.3) 53 (45.7)
2-3 yr 23 (28.4) 9 (25.7) 32 (27.6)
a 4 yr 17 (23.0) 14 (40.0) 31 (26.7) 0.09

Table 2—The Gender, Median Age and Age Distributions, Body Mass Index of TM, TBM, and BM Subgroups and Intergroup Comparison

Variables TM (n = 38) BM (n = 16) TBM (n = 27) Overall (n = 81) p Value
Gender 24 (63.2) 9 (56.3) 24 (88.9) 57 (70.4) 0.08t
Median age, yr 2.2 (0.4, 11.3) 1.8 (0.2, 11.7) 1.9 (0.2, 12.4) 1.9 (0.2, 12.4) 0.34J
Age group
< 2 yr 17 (44.7) 8 (50.0) 16 (59.3) 41 (50.6)
2-3 yr 12 (31.6) 4 (25.0) 7 (25.9) 23 (28.4)
a 4 yr 9 (23.7) 4 (25.0) 4(14.8) 17 (23.0) 0.80t
Body mass index, kg/m2 17.1 (12.7, 30.1) 17.5 (13.7, 25.9) 17.8 (13.5, 24.1) 17.5 (12.7, 30.1) 0.56t

Table 3—Illness Frequency, Unadjusted Relative Risk Ratios, and the Age and Gender RRadj for the Malacia and Control Groups

Variables No, IllnessFrequency! Relative Risk p Value
RRunadj (95% CI) RRadj (95% CI)
Age groups 0.39
< 2 yr 42 2.0 (0,9) 2.0 (1.2-3.4) 1.7 (1.0-2.8)
2-3 yr 26 1.0 (0,7) 1.4 (0.76-2.5) 1.2 (0.67-2.2)
a 4 yr 28 1.0 (0,6) 1.0 (reference) 1.0 (reference)
Gender 0.20
Male 62 2.0 (0,9) 1.2 (0.8-2.0) 1.2 (0.75-1.85)
Female 34 1.0 (0,6) 1.0 (reference) 1.0 (reference)
Groups 0.002 adjusted
Malacia 61 2.0 (0,9) 2.4 (1.5-3.8) 2.1 (1.3-3.4)
Control 35 1.0 (0,6) 1.0 (reference) 1.0 (reference)

Table 4—CARIFS-d1 Scores, Proportion of Children Who Had Returned to a Quarter of the Day 1 Score by 14 Days, and the age and gender RRadj CARIFS-d1 Scores of First Illness and the Age-Adjusted and Gender-Adjusted Hazard Ratio or the Likelihood of RQCS for Each of the Malacia and Control Groups

Variables No. CARIFS-D1 Scores RQCS
IMedian (Minimum, Maximum) RRadj IProportion Achieved RQCS Within 14 d, % HRadj (95% CI)
Age groups
< 2 yr 29 20.6 (4.0, 58.8) 0.88 (0.51-1.52) 51.7 0.77 (0.44-1.8)
2-3 yr 13 23.7 (3.0, 65.0) 1.13(0.62-2.06) 61.5 0.69(0.31-1.5)
a 4 yr 12 21.5 (2.0, 48.0) 1.0 (reference) 72.7 1.0 (reference)
Gender
Male 35 22.9 (2.0, 62.4) 0.79 (0.51-1.22) 52.9 0.72 (0.34-1.5)
Female 19 20.6 (3.0, 65.0) 1.0 (reference) 68.4 1.0 (reference)
Groups
Malacia 30 24.5 (3.0, 65.0) 1.66(1.8,2.56) 66.7 0.75 (0.36,1.57)
Control 24 17.5 (2.0, 48.0) 1.0 (reference) 50.0 1.0 (reference)

Table 5—Number of Days a Cough Diary Score of > 3 Was Recorded, Unadjusted Relative Risk, and the age and gender RRadj of Significant Coughing and Cough Interfering With Daily Activities

Variables No. Cough Diary Scoref Relative Risk p Value
RRunadj RRadj
Age groupsj
< 2 yr 26 3 (0, 9) 1.26 (0.40-3.92) 0.87 (0.54-1.40)
2-3 yr 8 0.5 (0, 9) 0.86 (0.21-3.58) 0.85 (0.46-1.57)
a 4 yr 8 2.5 (0, 9) 1.0 (reference) 1.0 (reference) 0.97
Genderj
Male 25 3 (0, 9) 1.36 (0.55-3.37) 1.13(0.76-1.66)
Female 17 0 (0, 9) 1.0 (reference) 1.0 (reference) 0.85
puorC
Malacia 18 4 (0, 9) 4.16(1.88-9.2) 4.17(2.54-6.85)
Control 24 0 (0, 7) 1.0 (reference) 1.0 (reference) < 0.001 adjusted
Age groups§
< 2 yr 26 0 (0, 8) 0.90 (0.3-3.6) 0.84 (0.21-3.31)
2-3 yr 8 0 (0, 3) 0.38 (0.05-3.1) 0.62 (0.08-4.54)
a 4 yr 8 0 (0, 6) 1.0 (reference) 1.0 (reference) 0.90
Gender§
Male 27 0 (0, 8) 2.0 (0.54-7.68) 2.2 (0.66-7.44)
Female 15 0 (0, 4) 10.0 (reference) 1.0 (reference) 0.20
Groups§
Malacia 18 1.5 (0, 8) 7.7 (2.1-27.4) 7.2 (1.91-27.2)
Control 24 0 (0, 3) 1.0 (reference) 1.0 (reference) 0.005 adjusted
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