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Flexible bronchoscopy has a high diagnostic yield, identifying underlying abnormalities in 87.5% of children with chronic nonspecific cough that remains unexplained after comprehensive noninvasive evaluation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 20, 2026Open Access

Bronchoscopic abnormalities in children with chronic nonspecific cough

RERehab ElmeazawyTanta University AMAhmed M.ElninyTanta University ARAhmed Mohamed Abdel RazikTanta University

Key Points

Assessing bronchoscopy and related diagnostic findings in children presenting with chronic nonspecific cough.
Prospective cross-sectional study involving 64 children aged 3 months to 18 years.
Standardized evaluation including clinical assessment, laboratory tests, chest X-ray, and high-resolution CT.
Flexible bronchoscopy conducted with bronchoalveolar lavage for cytological and microbiological analysis.
Bronchoscopy abnormalities were noted in 87.5% of cases, primarily purulent secretions and congenital airway anomalies.
BAL showed neutrophilia in 95.3% and positive cultures in 20.3% for Haemophilus influenzae and Streptococcus pneumoniae.
Predictive models demonstrated AUCs of 0.809 for predicting PBB and 0.912 for congenital airway anomalies, both statistically significant.

Abstract

Chronic nonspecific cough in children is a common and challenging clinical problem. Flexible bronchoscopy plays a crucial role in identifying underlying etiologies when non-invasive investigations are inconclusive. This study aimed to assess bronchoscopy and related diagnostic findings in children presenting with chronic cough. This prospective cross-sectional study included 64 children aged 3 months to 18 years who presented with chronic nonspecific cough lasting more than four weeks. All patients underwent a standardized evaluation that included clinical assessment, laboratory tests, chest X-ray, and high-resolution CT. Pulmonary function testing was performed in children older than five years. Flexible bronchoscopy was conducted, and bronchoalveolar lavage samples were examined for cytological and microbiological analysis. This prospective study included 64 children (32 males) with a median age of 8 months (IQR 36–84) with chronic cough, classified as dry (n = 38), wet (n = 21), or barking (n = 5) cough. Bronchoscopy revealed abnormalities in 87.5% of cases, most commonly purulent secretions and congenital airway anomalies. BAL showed neutrophilia in 95.3%, and cultures were positive in 20.3%, mainly for Haemophilus influenzae and Streptococcus pneumoniae. For predicting PBB, the combined multivariable model demonstrated good discriminative ability (AUC = 0.809, P = 0.004). Increasing age (OR = 1.038, P = 0.024) and tobacco smoke exposure (OR = 4.15, P = 0.04) were significant independent predictors. For congenital airway anomalies, the combined model demonstrated excellent predictive performance (AUC = 0.912, P < 0.001), outperforming individual clinical variables. Flexible bronchoscopy demonstrated a high diagnostic yield in children with chronic cough that remained unexplained following comprehensive noninvasive evaluation. However, a definitive assessment of its clinical utility requires direct comparison with other diagnostic modalities, which is addressed in the subsequent analysis.

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