Background. Identifying a foreign body aspiration (FBA) still remains a diagnostic difficulty. Moreover, the indications for bronchoscopy in subjects of suspected foreign bodies are not clear. The aim of this study was to evaluate the effectiveness of pediatric pulmonologists in diagnosing FBA. Methods. This was a retrospective, single-center study on children who underwent rigid bronchoscopy for suspected FBA. Data on the patients were obtained from the medical records. Patients who had foreign bodies (FB) identified during rigid bronchoscopy were classified as FB positive, and those in whom rigid bronchoscopy did not detect FB were defined as FB negative. Demographic data as well as consultation status with a pediatric pulmonologist were compared between these two groups. Furthermore, the patients were categorized into three groups based on their clinical scores that assessed the likelihood of the presence of FB: low risk, moderate risk, and high risk. Results. Out of 474 rigid bronchoscopies, 232 (48.9%) detected FB. Consultation by a pediatric pulmonologist was not requested in 388 (81.8%). Out of these 388 patients, 206 (53%) were negative for FB. In terms of FB detection success, there was no difference between individuals who sought pulmonology consultation and those who did not (58.1% vs. 53.1% respectively, p=0.059). However, when the children were categorized based on their risk levels, the incidence of detecting FB among children in low-risk group was 42% when they received consultation from the pulmonology department, whereas this incidence dropped to 5.6% when pulmonology consultation was not sought (p<0.001). Conclusions. Consulting a pediatric pulmonologist, particularly for low-risk individuals, might reduce the likelihood of performing unnecessary bronchoscopies. Given that rigid bronchoscopy is an intrusive technique, it is crucial to reduce the number of negative bronchoscopies in order to mitigate complications associated with it.

Introduction: Hemoptysis is rare among children. The aim of this study was to reveal the contribution of flexible fiberoptic bronchoscopy (FFB) in children with unresolved hemoptysis. Method: From February 2014 to February 2024, a retrospective analysis was conducted on patients who underwent FFB at a tertiary care institution due to the indication of hemoptysis. Results: Of the 29 children included in the study, the mean (SD) 11.5±0.73 years at the time of FFB. Hemoptysis was mild to moderate in most children (n=27, 93%). Patients who had severe hemoptysis required transfusion; both had pneumonia. Vascular pathologies (n=8, 28%), Munchausen by proxy syndrome (MBP) (n=7, 24%), infectious pathologies (n=5, 18%),bronchiectasis (n=3, 10%), pulmonary hemosiderosis (n=1, 3%), upper airway malformation (n=1, 3%) and platelet dysfunction (n=1, 3%) were detected in the patients. The etiology of 3 patients could not be determined. Morphological and histochemical findings in favor of Actinomyces were detected in the bronchoalveolar lavage fluid pathology of a patient with necrotizing pneumonia. 4 patients with vascular pathology revealed lesions that were not seen on thoracic CT, one of which had tortuous dysplastic artery. In 3 patients, the location of bleeding was determined with FFB and embolization was performed with angiography. On the other hand, bronchoscopy was normal in 37.9% (n=11) of the patients. Conclusion: If the bleeding localization or underlying cause of hemoptysis in children cannot be determined, FFB is very valuable despite advanced radiological diagnostic methods. MBP is also an important diagnosis that should be considered in etiology.

Introduction: Pulmonary function tests and polysomnography (PSG) serve as an important tool in the management of neuromuscular disorders. Our aim is to define characteristics of sleep apnea syndrome (SAS) in DMD patients who had PSG data. Method: This retrospective study includes 54 DMD patients (≤ 18 years) referred to sleep laboratory between January 2016-July 2023. Results: The average age and body mass index at the time of PSG was 11.1±3.8 years;19±4kg/m2. Of the patients, 25.9%(n=14) were non-ambulatory; 40.7% (n=22) had scoliosis. Mean values for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC); FEV1 and FVC zscores were 84.7±26.4%pred; 73.7±22.6%pred;-1.9±2.7; -3.7±2.8. Mean ejection fraction (EF) was 62.1±9.5. Hypoventilation was documented in 9.2% (n=5); SAS was classified as moderate/severe in 27.7% (n=15), and mild in 37% (n=20). Fifteen patients (27.7%) within the study cohort required noninvasive mechanic ventilation. A weak positive correlation was found between age at the time of PSG and the severity of AHI (p= 0.015; r:0.33). Diseases’ stage was positively correlated with age and AHI severity (p<0.001, r:0.7; p= 0.027, r: 0.41); negatively correlated with FEV1 zscore, FVC zscore, EF (p<0.001, r:-0.7; p<0.001, r:-0.65; p= 0.02, r:-0.3). EF was significantly lower in patients with moderate/severe SAS compared to patients with mild SAS (p=0.017, p=0.04). FVC below 80% was associated with the risk of SAS (OR: 15.6, p=0.003). Conclusion: This study is yet another example highlighting the value of pulmonary function tests and PSG studies as a core component of standards of care in proactive management of DMD patients.

Background: In this study, we aimed to evaluate the losses in the gains of children who had to discontinue their modulator therapies due to drug delivery procedures. Methods: Demographic, clinical, microbiologic, radiologic, and pulmonary function test parameters of twelve CF children, were evaluated. Parameters were divided into three groups as ‘before treatment’ (BT), ‘during treatment’ (DT) and ‘after interruption of treatment’ (AT) to show differences between. Results: There was a significant increase in forced expiratory volume in 1 s (FEV1) z-score, body mass index (BMI) z-score and Cystic Fibrosis Questionnaire-Revised respiratory domain score (CFQR-RS) of DT compared with the values BT (p=0.001, p=0.012, p<0.001; respectively). It was found that FEV1 z-score, BMI z-score and CFQR-RS of DT decreased significantly compared with the values AT (p=0.003, p=0.01, and p<0.001, respectively). When post and pre-treatment levels were compared, there was no significant difference between FEV1 z-score (p=0.07), BMI z-score (p=0.56), CFQR-RS (p=0.7). Half of patients had percent-predicted forced expiratory volume levels with a drop of more than 20%. It was also detected that Pseudomonas aeruginosa colonization was a significant factor in degradation of FEV1 z score to the lower pre-treatment levels. Conclusion : This is the first retrospective detailed study about discontinuation of modulatory therapies in children. Our study shows the importance of treatment continuation as well as the patients access to these drugs. We hope that this study will raise awareness about the regular long-term use of modulator therapies. To make these therapies available worldwide, immediate action is required.