The findings of a clinical surveillance bronchoalveolar lavage programme in pre-school patients with cystic fibrosis

Background: Evidence suggests infection is present in the lower airways of young children with cystic fibrosis (CF), even when clinically stable. Oropharyngeal samples (OPS) are typically used for airway surveillance in these children but have been shown to have low positive predictive values and low sensitivity in detecting lower airway infection when compared with the reference standard, bronchoalveolar lavage (BAL).

Methods: The aim of this study was to determine the prevalence of pathogens in lower airway samples detected as part of a pilot clinical BAL surveillance programme, in young children aged from one to six years old, and to ascertain if their detection resulted in a change in treatment.

Results: During the study 78 bronchoscopies were performed on 38 patients. The average age at the time of bronchoscopy was 2.7 years (range 0.3-7.0 year). A significant organism was detected in 58 (74.5%) BALs. Haemophilus influenzae was detected in 27 (34.6%) samples, 16 (20.5%) samples had Staphylococcus aureus, and nine (11.5%) had Pseudomonas aeruginosa. Change in treatment occurred after 46 (58.9%) BALs.

Conclusions: This study suggests that, in young non-expectorating children with CF, routine surveillance bronchoscopy allows the detection of significant lower airway pathogens and provides the opportunity for targeted treatment of sub-clinical infection.