Faculty Bibliography

Bronchoalveolar lavage (BAL) is an essential tool for characterizing pediatric pulmonary diseases, but its diagnostic yield is often hampered by technical collection errors and challenges in interpreting results, particularly with the rise of non-culture-based microbiological techniques. Based on a scoped literature review and expert experience, this paper aims to standardize proper BAL technique, detail common procedural mistakes, and establish an updated interpretative framework for pediatric pulmonologists. Understanding these procedural and diagnostic pitfalls is crucial to maximizing the diagnostic utility of BAL and minimizing errors in the management of pediatric lung disease. It is recommended that the subject be taught using a combination of didactic and practical sessions.

We present two pediatric patients with severe uncontrolled asthma who underwent aerodigestive evaluation revealing eosinophilic asthma and eosinophilic esophageal inflammation. They were subsequently initiated on targeted biological therapy for eosinophilic inflammation with dupilumab resulting in clinical and histological improvement. These cases demonstrate that aerodigestive evaluation is an important clinical tool for characterizing asthma phenotypes and diagnosing comorbidities in children with SUA to optimize their treatment regimens.

Cough is a common pediatric condition. Acute cough is often considered to be self-limiting and not requiring clinical management. However, pediatric patients and their parents often seek remedies for an acute cough. Traditional Chinese Medicine (TCM) specialists have been treating pediatric cough for millennia. Here we present a case of pediatric cough and the approaches taken to it by a Western and Chinese respiratory specialist. We conclude that TCM may provide important and useful insights into the treatment of such pediatric respiratory disease.

Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.

Pediatric pulmonologists have been involved in the care of adult COVID-19 patients in a variety of ways, particularly in areas with a high concentration of cases. This invited commentary is a series of questions to Dr Mikhail Kazachkov, a pediatric pulmonologist at New York University, about his experiences to date in a major COVID-19 "hotspot" and his thoughts about how other pediatric pulmonologists facing this situation can best support their colleagues.

Endobronchial sarcoid lesions have previously been described and visualized upon bronchoscopy in adult patients with pulmonary sarcoid involvement. Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TBNA) has come into favor as the preferred method of diagnosis, but it remains a novel technique in pediatric pulmonology. We describe the first two known cases of visualized endobronchial sarcoid lesions in the pediatric population with pathological confirmation of sarcoidosis with endobronchial and EBUS-TBNA biopsies.