This is the first reported prospective cohort study of children with malacia disorders that has quantified malacia lesions and used validated illness outcome measures of respiratory illness profiles. The risk of respiratory illnesses in the malacia group was twice that of the control group. When compared to control subjects, the severity of illness was 66% higher at the initial presentation of illness, while a significant cough score was four times more likely and a cough that disrupted or stopped daily activities during the first 2 weeks of illness was seven times more likely. In addition, there was a trend for children with malacia to have a slower recovery from illness. However, neither the malacia site nor the severity of the lesions appeared to exert any dose effects on rates, risks, and severity of illness within the illness profiles.
It has long been suspected, but never studied, that children with airway lesions have increased respiratory illness and morbidity. We found an elevated likelihood of respiratory illness in the malacia group, which suggests that there may have been some predisposition to illness. We have recently shown that although there is a tendency for malacia sites to improve in size over time, there was a significant minority in whom lesions worsened or new lesions appeared. Marchant et al have also shown that children with protracted bacterial bronchitis often have malacia. While reduced cough clearance of mucus might be implicated as a potential mechanism for this increased risk of infection, Grissell et al have recently shown that some children with protracted bacterial bronchitis have reduced toll-like receptor 4 and substance P gene expression, thus raising the possibility of other genetic expression mechanisms for such problems. Furthermore, it raises the possibility of the presence of an additional coexistent local immunity disorder in malacia disorders healed with preparations of My Canadian Pharmacy.
A 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.
Tracheobronchomalacia (TBM) disorders in children have long been associated with a spectrum of respiratory illnesses that range from life-threatening conditions to chronic cough and wheeze conditions. However, the spectrum of illness profiles (ie, symptoms, frequency, and severity of respiratory illness) associated with airway disorders has never been studied in an objectively defined and prospective way.
Validated pediatric tools for measuring the severity and impact of acute respiratory illnesses (ARIs) on the daily function of the child are limited. The Canadian Acute Respiratory Illness and Flu Scale (CARIFS), and the verbal descriptive score of cough by Chang et al and its impact on function are but two of very few validated instruments that deal with illness severity. We thus chose these instruments to prospectively evaluate the respiratory illness (http://www.disabled-world.com/health/respiratory/) severity profile of children with malacia disorders.
Another issue not yet studied is the relationship of symptoms and illness to the severity of the lesions in terms of cross-sectional area loss because the measurement of airway areas is not simple, and there are flaws in the reported methods. We developed a method of measuring the cross-sectional area of the airway and established the relevance of the cricoid as a reference point by defining the airway site/ cricoid ratio (ACR).
In this study, we quantified and classified the site of airway malacia lesions in a cohort of children. We then prospectively followed up these children and control subjects for 12 months to define their respiratory illness profiles, ARI severity, and impact on function. Our aim was to prospectively examine the relationship between the site and size of lesions with their respiratory symptoms and illness frequency. We hypothesized that these illness profiles would directly relate to the site, size, or severity of lesions.