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Aspiration

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Diagnostic and Interventional Bronchoscopy in Children

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Chronic pulmonary aspiration is the repeated passage of material into the trachea and bronchi. Aspirated material may include food or drink, gastroesophageal refluxate, or saliva. Chronic pulmonary aspiration is a common problem in pediatrics that can be associated with various anatomic defects, neurologic abnormalities, genetic syndromes, or gastrointestinal disorders. Diagnosis and management of chronic aspiration can improve respiratory illness frequency, daily symptom burden, and quality of life, and also prevent or delay the development of chronic lung disease and bronchiectasis. The evaluation of chronic pulmonary aspiration can be challenging and may require multiple studies to diagnose and determine the etiology of aspiration. There is no gold standard for the diagnosis of chronic pulmonary aspiration. Flexible bronchoscopy can diagnose structural and dynamic airway abnormalities, determine lower airway secretion burden, and obtain lower airway specimen via bronchoalveolar lavage. Flexible bronchoscopy may be therapeutic if performed following an acute aspiration event. Bronchoalveolar lavage can help determine the degree of lower airways inflammation and diagnose lower respiratory tract infection. Lipid-laden macrophages are commonly obtained but are neither sensitive nor specific for diagnosing chronic pulmonary aspiration. The aerodigestive model utilizes a multidisciplinary team to coordinate multiple procedures and studies for children with suspected or known chronic pulmonary aspiration and other aerodigestive disorders. The aerodigestive evaluation, which includes flexible bronchoscopy as part of the “triple scope,” has been proven to decrease hospital charges and may reduce the burden on families by decreasing the number of clinic appointments and anesthetics needed to complete the evaluation of chronic pulmonary aspiration.

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Authors and Affiliations

  1. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Gregory Burg

  2. Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Gregory Burg

  3. Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA

    Dan Benscoter

  4. Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Dan Benscoter

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Editors and Affiliations

  1. Division of Pulmonary Medicine, Children’s Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA

    Samuel Goldfarb

  2. Division of Pulmonary Medicine & Center for Pediatric Airway Disorders, Children’s Hospital of Philadelphia University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Joseph Piccione

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Burg, G., Benscoter, D. (2021). Aspiration. In: Goldfarb, S., Piccione, J. (eds) Diagnostic and Interventional Bronchoscopy in Children. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-54924-4_22

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