Obstructive ventilatory defects in pediatrics

Obstructive airway syndromes are the most common cause of respiratory symptoms in infants and children. By the age children are capable of performing spirometry correctly (developmental age > 6 yr) most congenital syndromes and severe diseases (cystic fibrosis) have been detected, but this is not invariably the case! As asthma is so common it is not exceptional for children to have a second respiratory disorder. One way to categorize obstructive syndromes is by the site of the abnormality.

High extrathoracic disorders

• Pierre Robin syndrome
• choanal atresia or stenosis
• CHARGE syndrome
• vocal chord paralysis (uni- or bilateral)
• subglottic or tracheal stenosis (congenital, acquired), hemangioma, fibroma, papilloma
• infectious: laryngitis subglottica, epiglottitis (uncommon in children > 6 yr), laryngotracheobronchitis, retropharyngeal abscess

Central (intrathoracic) disorders

• tracheo- and/or bronchomalacia (congenital, isolated or in combination with other congenital abnormalities)
• tracheo- and/or bronchomalacia acquired, such as due to bronchopulmonary disease
• aspiration (gastric content, saliva, foreign body)
• compression of trachea or bronchi by congenital vascular anomalies, space occupying lesions (bronchogenic cysts, tuberculosis, lymphoma)
• congenital emphysema, congenital cysto-adenomatous malformation of the lung

Peripheral disorders

• asthma
• relatively narrow airways (risc factors: due to prenatal maternal smoking, low birth weight, small for gestational age, intra-uterine growth retardation, lung hypoplasia, boy)
• sequel of viral or bacterial infections (cysts for abscess, bronchiectasies)
• chronic bronchitis due to recurring aspirations, immune defects, primary ciliary dyskinesia, bronchiectasis, cystic fibrosis, other causes of disturbed mucociliary clearance
• congenital abnormalities such as congenital emphysema, congenital cysto-adenomatous malformation of the lung, sequesters, intraparenchymal cysts