Bronchoscopic abnormalities in children with chronic nonspecific cough

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.